Provider Demographics
NPI:1366611725
Name:EAST TEXAS CASE MANAGEMENT REFERRAL SERVICE
Entity type:Organization
Organization Name:EAST TEXAS CASE MANAGEMENT REFERRAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER/CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-295-0098
Mailing Address - Street 1:2300 BILL OWENS PKWY
Mailing Address - Street 2:915
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3033
Mailing Address - Country:US
Mailing Address - Phone:903-295-0098
Mailing Address - Fax:903-295-0098
Practice Address - Street 1:2300 BILL OWENS PARKWAY
Practice Address - Street 2:915
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:903-295-0098
Practice Address - Fax:903-295-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251B00000XMedicaid