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General NPI Number Information
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NPI Number | 1770810525
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Entity Type | Organization
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Legal Business Name | AZINA PLACE INC.
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Dates
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Enumeration Date | 11/14/2009
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1505 NORTHWEST HWY
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City | GARLAND
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State | TX
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Zip | 75041-5231
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Country | US
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Telephone | 469-814-0300
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Fax | 469-814-9073
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Provider Business Mailing Address
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Address Line | 1505 NORTHWEST HWY
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City | GARLAND
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State | TX
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Zip | 75041-5231
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Country | US
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Telephone | 214-402-0076
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Fax | 469-814-0300
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Authorized Official
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Title or Position | DIRECTOR-OWNER
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Name | ROSE MSEWE
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Credential |
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Telephone | 214-402-0076
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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 |
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License Number State | TX
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