Provider Demographics
NPI:1285482075
Name:REBIRTH INC.
Entity type:Organization
Organization Name:REBIRTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-608-0295
Mailing Address - Street 1:2340 E TRINITY MILLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1947
Mailing Address - Country:US
Mailing Address - Phone:469-608-0295
Mailing Address - Fax:903-913-7274
Practice Address - Street 1:2340 E TRINITY MILLS RD STE 300
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1947
Practice Address - Country:US
Practice Address - Phone:469-608-0295
Practice Address - Fax:903-913-7274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBIRTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility