Organization Name: | PECAN VALLEY MHMR REGION |
NPI Number: | 1073731105 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RALPH WHAITE (MIS DIRECOTR) |
Mailing Address: | 1018 Highland Rd Cleburne |
State: | TX US |
Postal Code: | 760338615 |
Phone Number: | 8175580452 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 1014219 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |