# PALOMA PLACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508504168
- **Authorized official:** MONTRAY JOHNSON (CEO)
- **Authorized official phone:** (361) 271-3371

## Contact information

- **Practice address:** 2058 FM 665 RD, CORPUS CHRISTI, TX 78415-6830
- **Practice address phone:** (361) 271-3298
- **Practice address fax:** (361) 236-2945
- **Mailing address:** 2058 FM 665 RD, CORPUS CHRISTI, TX 78415-6830
- **Mailing address phone:** (361) 271-3298
- **Mailing address fax:** (361) 236-2945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2022
- **Last updated:** 05/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 26290059 | — | TX |