Organization
THE POLO GROUP LLC
Active
Other names
The Polo Group
Organization subpart
No
Provider details
NPI number
Authorized official
LILLIAM POLO LCDC (CEO)
(972) 906-9112
Entity
Organization
Contact information
Practice address
1626 W HIGHWAY 287 BUSINESS STE 101, WAXAHACHIE, TX 75165-4728
(972) 906-9112
(972) 906-9112
Mailing address
1626 W HIGHWAY 287 BUSINESS STE 101, WAXAHACHIE, TX 75165-4728
(972) 906-9112
(972) 906-9112
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013287721
—
TX
Enumeration date
04/15/2020
Last updated
04/15/2020
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