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General NPI Number Information
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NPI Number | 1710179171
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Entity Type | Organization
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Legal Business Name | NORTH NINTH HOUSE
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 4210 N 9TH ST
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City | ABILENE
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State | TX
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Zip | 79603-5464
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Country | US
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Telephone | 325-677-6815
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Fax | 325-673-7829
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Provider Business Mailing Address
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Address Line | PO BOX 1880
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City | ABILENE
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State | TX
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Zip | 79604-1880
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Country | US
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Telephone | 325-677-6815
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Fax | 325-673-7829
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. DICKIE GREENWOOD
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Credential |
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Telephone | 325-677-6815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 000781401
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License Number State | TX
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