Noah'S Glen Residential Treatment Center

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

2362A Issued in TX

Legal business name

NOAH'S GLEN RESIDENTIAL TREATMENT CENTER

Practice address

2121 Mansfield St
Houston, TX 77091-4033

Phone

(713) 683-9144

Fax

(713) 683-9143

NPI assigned

Dec 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dudley T Farenthold, LCSW

Title

Ceo

Phone

(713) 683-9144

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679638639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 MANSFIELD ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770914033",
            "telephone_number": "713-683-9144",
            "fax_number": "713-683-9143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 MANSFIELD ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770914033",
            "telephone_number": "713-683-9144",
            "fax_number": "713-683-9143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOAH'S GLEN RESIDENTIAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FARENTHOLD",
        "authorized_official_first_name": "DUDLEY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "713-683-9144",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "TX",
            "license": "2362A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "2362A",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Children's Substance Abuse Rehabilitation Facility in Houston, TX
• Providers in Houston, TX by specialty
• Children's Substance Abuse Rehabilitation Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.