Organization Name: | EST 400 OF WACO LLC |
NPI Number: | 1033554837 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUBY C SANTIBANEZ (BUSINESS/OFFICE MANAGER) |
Mailing Address: | 4555 Lake Shore Dr Waco |
State: | TX US |
Postal Code: | 767101814 |
Phone Number: | 2547760400 |
Fax Number: | 2547760637 |
NPI Enumeration Date: | 05/07/2013 |
NPI Last Update Date: | 05/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |