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Organization
EST 400 OF WACO LLC
Active
Organization
EST 400 OF WACO LLC
Active
Other names
Lake Shore Center for Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
RUBY C SANTIBANEZ (BUSINESS/OFFICE MANAGER)
(254) 776-0400
Entity
Organization
Contact information
Practice address
4555 LAKE SHORE DR, WACO, TX 76710-1814
(254) 776-0400
(254) 776-0637
Mailing address
4555 LAKE SHORE DR, WACO, TX 76710-1814
(254) 776-0400
(254) 776-0637
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/07/2013
Last updated
05/07/2013
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