Organization
SAM'S PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ANDRIE FORD (PROGRAM MANAGER)
(713) 301-5383
Entity
Organization
Contact information
Practice address
1130 WESTGATE DR, WHARTON, TX 77488-5714
(713) 301-5383
(979) 282-9145
Mailing address
1130 WESTGATE DR, WHARTON, TX 77488-5714
(979) 282-9145
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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