| NPI | 1053695403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VASHON MCCOY Program Manager 903-917-6465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TX 10535847) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2012-04-09 |