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General NPI Number Information
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NPI Number | 1760089767
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Entity Type | Organization
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Legal Business Name | FIFTH DIRECTION
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Dates
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Enumeration Date | 10/04/2020
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Last Update Date | 10/04/2020
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Provider Practice Location Address
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Address Line | 4320 AVENUE R 1/2 REAR
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City | GALVESTON
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State | TX
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Zip | 77550-7346
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Country | US
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Telephone | 281-619-8550
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 AVENUE R 1/2 REAR
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City | GALVESTON
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State | TX
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Zip | 77550-7346
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Country | US
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Telephone | 281-780-9014
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Fax |
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Authorized Official
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Title or Position | FACILITATOR
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Name | DEAN ALAN SIMS
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Credential | LCDC
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Telephone | 281-780-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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