Organization
PECAN VALLEY MHMR REGION
Active
Other names
Emerald Point
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH WHAITE (MIS DIRECTOR)
(940) 397-3147
Entity
Organization
Contact information
Practice address
271 DIAMOND LN N, BURLESON, TX 76028-6729
(817) 295-3056
Mailing address
650 W GREEN ST, STEPHENVILLE, TX 76401-3311
(254) 965-7806
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1014222
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1014222
DADS CONTRACT
—
Enumeration date
04/26/2007
Last updated
08/22/2020
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