| NPI | 1194382374 |
|---|---|
| Former Legal Business Name | WALLACE PLACE IN THE PINES |
| Entity Type | Organization |
| Authorized Contact | BARBARA ANN WALLACE Owner 936-662-5617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 102X00000X Poetry Therapist |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2019-06-04 |