Basic Information
| Provider Information | |||||||||
| NPI: | 1972194009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLLTON SPRINGS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 5TH ST STE 3850 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0258710075 | ||||||||
| FaxNumber: | 5025834446 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 N LAKE FOREST DR | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696341270 | ||||||||
| FaxNumber: | 4696341271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2021 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | WALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4124965959 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARROLLTON SPRINGS, LLC | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 387783901 | 05 | TX | MEDICAID |