Provider Demographics
NPI: | 1538214200 |
---|---|
Name: | THE WARREN CENTER, INC |
Entity type: | Organization |
Organization Name: | THE WARREN CENTER, INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | AMY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SPAWN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | SLP |
Authorized Official - Phone: | 972-490-9055 |
Mailing Address - Street 1: | 320 CUSTER RD |
Mailing Address - Street 2: | |
Mailing Address - City: | RICHARDSON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75080-5623 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-490-9055 |
Mailing Address - Fax: | 972-490-9058 |
Practice Address - Street 1: | 320 CUSTER RD |
Practice Address - Street 2: | |
Practice Address - City: | RICHARDSON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75080-5623 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-490-9055 |
Practice Address - Fax: | 972-490-9058 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-24 |
Last Update Date: | 2021-02-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 133VN1004X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | Group - Multi-Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Multi-Specialty |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 017436901 | Medicaid | |
TX | 017436902 | Medicaid |