Organization Name: | SAFE HAVENS OF KORNERSTONE |
NPI Number: | 1538393947 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DALE SMITH (EXECUTIVE DIRECTOR) |
Mailing Address: | 3221 W Pioneer Pkwy Pantego |
State: | TX US |
Postal Code: | 760134620 |
Phone Number: | 8172769009 |
Fax Number: | 8172769084 |
NPI Enumeration Date: | 05/13/2009 |
NPI Last Update Date: | 05/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |