Provider Demographics
NPI:1053918151
Name:THE SALVATION ARMY, A GEORGIA CORP. - MABEE CENTER
Entity type:Organization
Organization Name:THE SALVATION ARMY, A GEORGIA CORP. - MABEE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTRUBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:404-728-1300
Mailing Address - Street 1:1855 E. LANCASTER AVE.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2123
Mailing Address - Country:US
Mailing Address - Phone:817-344-1831
Mailing Address - Fax:817-338-9251
Practice Address - Street 1:1855 E. LANCASTER AVE.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2123
Practice Address - Country:US
Practice Address - Phone:817-344-1831
Practice Address - Fax:817-338-9251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY, A GEORGIA CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124732699OtherUEIN (DUNS)