Doctor Name: | TINA C. WADE |
NPI Number: | 1336386192 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1303 E Alamo St Brenham, TX - 778333823 |
Business Phone Number: | 9796614664 |
Business Fax Number: | |
Mailing Address: | Po Box 1765, BRENHAM |
State: | TX |
Postal Code: | 778341765 |
Phone Number: | 9796614664 |
Fax Number: | |
NPI Enumeration Date: | 01/15/2009 |
NPI Last Update Date: | 01/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
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. |