East Texas Treatment Center
Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) in Kilgore, TX. Organization (NPI-2).
NPI number1023002425
StatusActive
Last updated in NPPESFeb 17, 2022
Details
- NPI
- 1023002425
- Entity type
- Organization (NPI-2)
- Legal business name
- East Texas Treatment Center
- Organization subpart
- No
- Enumeration date
- Aug 31, 2005
- Certification date
- Feb 17, 2022
- Last updated
- Feb 17, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0401X | Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | – | TX | Yes |
| 225100000X | Physical Therapist | 605680000 | TX |
Practice location
1200 Dudley RdKilgore, TX 75662-3306
Phone 903-984-5571 · Fax 903-984-1913
Mailing address
1200 Dudley RdKilgore, TX 75662-3306
Phone 903-984-5571 · Fax 903-984-1913
Authorized official
Terry Hardan
Executive Director
9039845571
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