Provider Demographics
NPI:1174547780
Name:ANDREWS CENTER/ SHORT ST
Entity type:Organization
Organization Name:ANDREWS CENTER/ SHORT ST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-597-1351
Mailing Address - Street 1:205 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2609
Mailing Address - Country:US
Mailing Address - Phone:903-567-4541
Mailing Address - Fax:
Practice Address - Street 1:205 SHORT ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2609
Practice Address - Country:US
Practice Address - Phone:903-567-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities