East Texas Treatment Center

LBN: East Texas Treatment Center
East Texas Treatment Center is an health care organization with primary practice located at 1200 Dudley Rd , Kilgore TX 75662-3306. The organization recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Ambulatory Health Care Facilities / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF). Ambulatory Health Care Facilities / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) is the primary health care specialty. East Texas Treatment Center can be contacted via phone (903) 984-5571, or through Hardan, Terry via phone (903) 984-5571.

Contact Information

Primary practice address
1200 Dudley Rd Kilgore TX 75662-3306
Phone: (903) 984-5571
Fax: (903) 984-1913
Website:
Map and Directions
Authorized official contact:
Name: Hardan, Terry
Phone: (903) 984-5571

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 605680000 Texas
Ambulatory Health Care Facilities / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Texas

Profile Details

NPI number 1023002425
LBN Legal business name East Texas Treatment Center
DBA Doing business as
Authorized official Hardan, Terry
Entity Organization
Organization subpart 1 No
Enumeration date Aug 31st, 2005
Last updated Feb 17th, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023002425 NPPES
Texas MEDICAID 121835602

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