Organization
GULF BEND MRMR CENTER HCS PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD L POLZIN (EXECUTIVE DIRECOTR)
(361) 575-0611
Entity
Organization
Contact information
Practice address
6502 NURSERY DR, SUITE 100, VICTORIA, TX 77904-1178
(361) 575-0611
(361) 582-2323
Mailing address
6502 NURSERY DR., SUITE 100, VICTORIA, TX 77904-4112
(361) 575-0611
(361) 582-2329
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001007430
CONTRACT NUMBER
TX
Enumeration date
07/10/2006
Last updated
08/28/2009
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