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General NPI Number Information
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NPI Number | 1790948842
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Entity Type | Organization
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Legal Business Name | NORTHVIEW DEVELOPMENT CENTER
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 401 W MOSS ST
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City | EASTLAND
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State | TX
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Zip | 76448-1754
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Country | US
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Telephone | 254-629-2624
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Fax | 254-629-3950
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | EASTLAND
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State | TX
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Zip | 76448-0148
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Country | US
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Telephone | 254-629-2624
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Fax | 254-629-3950
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PATSY WILSON
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Credential |
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Telephone | 254-629-2624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 123425
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License Number State | TX
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