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NPI Code Detail

MEDICARE: ANDREWS CENTER/CHOCTAW

MEDICARE: ANDREWS CENTER/CHOCTAW
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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1235153842
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDREWS CENTER/CHOCTAW
Provider Business Mailing Address
First Line : 13470 CHOCTAW DR
Second Line :
City : TYLER
State : TX
Zip : 75709-5000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13470 CHOCTAW DR
Second Line :
City : TYLER
State : TX
Zip : 75709-5000
Country : US
Telephone Number : 903-595-1443
Fax Number :
Authorized Official
Title or Position : CFO
Name : CAROL FONTENOT
Credential :
Telephone Number : 903-597-1351
Provider Enumeration Date : 07/27/2006
Last Update Date : 08/22/2020

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Directions to “ANDREWS CENTER/CHOCTAW ” Practice Location

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