MEDICARE: ANDREWS CENTER/ SHORT ST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1174547780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREWS CENTER/ SHORT ST

Provider Business Mailing Address
First Line	:	205 SHORT ST
Second Line	:
City	:	CANTON
State	:	TX
Zip	:	75103-2609
Country	:	US
Telephone Number	:	903-567-4541
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 SHORT ST
Second Line	:
City	:	CANTON
State	:	TX
Zip	:	75103-2609
Country	:	US
Telephone Number	:	903-567-4541
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CAROL FONTENTO
Credential	:
Telephone Number	:	903-597-1351

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/22/2020

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