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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