| NPI | 1942759535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRACLE WAGNER CEO/Director 817-264-6048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 72494) |
| Enumeration Date | 2016-09-24 |
| Last Update Date | 2019-06-11 |