Organization
CHRONIC DISEASE MANAGEMENT CENTERS OF TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESSIA LYDON POLK (CHIEF EXECUTIVE OFFICER)
(214) 729-8750
Entity
Organization
Contact information
Practice address
600 METHODIST ST APT 2120, RED OAK, TX 75154-4262
(469) 552-9911
(972) 223-7383
Mailing address
1725 S HOUSTON SCHOOL RD, LANCASTER, TX 75146-3926
(214) 729-8750
(972) 223-7383
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2127329
TX
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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