Organization
PRAIRIE HARBOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL BRYANT (EXECUTIVE DIRECTOR)
(979) 217-1581
Entity
Organization
Contact information
Practice address
7146 HIGHWAY 60, WALLIS, TX 77485-9507
(979) 217-1581
Mailing address
PO BOX 517, WALLIS, TX 77485-0517
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/16/2013
Last updated
02/28/2014
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