Basic Information
| Provider Information | |||||||||
| NPI: | 1134401466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLLTON SPRINGS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARROLLTON SPRINGS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 5TH ST | ||||||||
| Address2: | SUITE 3850 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024008496 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2225 PARKER RD | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722424114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2011 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | WALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4124965959 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | TX | Y | Hospitals | Psychiatric Hospital |
No ID Information.