Organization
PALOMA PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONTRAY JOHNSON (CEO)
(361) 271-3371
Entity
Organization
Contact information
Practice address
2058 FM 665 RD, CORPUS CHRISTI, TX 78415-6830
(361) 271-3298
(361) 236-2945
Mailing address
2058 FM 665 RD, CORPUS CHRISTI, TX 78415-6830
(361) 271-3298
(361) 236-2945
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26290059
—
TX
Enumeration date
05/24/2022
Last updated
05/24/2022
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