Provider Demographics
NPI:1386953214
Name:STRAWBERRY CREEK OUTREACH CENTER, INC.
Entity type:Organization
Organization Name:STRAWBERRY CREEK OUTREACH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:817-819-6475
Mailing Address - Street 1:6401 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-9605
Mailing Address - Country:US
Mailing Address - Phone:817-819-6475
Mailing Address - Fax:206-350-4401
Practice Address - Street 1:6401 LUCERNE DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-9605
Practice Address - Country:US
Practice Address - Phone:817-819-6475
Practice Address - Fax:206-350-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty