Provider Demographics
NPI:1396244695
Name:TEXAS INSTITUTE FOR REHABILITATIVE SERVICES
Entity type:Organization
Organization Name:TEXAS INSTITUTE FOR REHABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSW
Authorized Official - Phone:804-514-9696
Mailing Address - Street 1:1431 GREENWAY DR STE 800
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2574
Mailing Address - Country:US
Mailing Address - Phone:757-514-9696
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR STE 800
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2574
Practice Address - Country:US
Practice Address - Phone:757-514-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health