=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871892182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WESTFIELD CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2011
-----------------------------------------------------
Last Update Date | 03/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5501 AUSTIN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-526-1791
-----------------------------------------------------
Fax | 713-526-1792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4617 MONTROSE BLVD C205
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-528-2008
-----------------------------------------------------
Fax | 713-528-2080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. MICHAEL R PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-528-2008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 1238429
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------