Organization
NACOGDOCHES PEDIATRIC CARE
Active
Other names
Nacogdoches Pediatric Extended Care
Organization subpart
No
Provider details
NPI number
Authorized official
MISTI HAJJ (OWNER)
(318) 348-5945
Entity
Organization
Contact information
Practice address
124 CREEKBEND BLVD, NACOGDOCHES, TX 75965-1780
(193) 623-4085
Mailing address
2407 PINEHURST DR, MONROE, LA 71201-2314
(318) 348-5945
Taxonomy
Speciality
Code
Description
License number
State
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4053464
—
TX
Enumeration date
09/07/2018
Last updated
08/17/2022
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