Organization
BLUEBONNET TRAILS MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NORALISA WILLIAMS (CREDENTIALING COORDINATOR)
(512) 244-8374
Entity
Organization
Contact information
Practice address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
NO LICENSE
TX
Other
Enumeration date
05/30/2007
Last updated
08/25/2023
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