| NPI | 1720294762 |
|---|---|
| Other Name | WEST LANE ICFMR |
| Entity Type | Organization |
| Authorized Contact | YOLANDA MONTES Enrollment COO Rdinator 817-569-5235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-08-18 |