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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KEVIN L MULLEN (DIRECTOR)
(936) 776-2094
Entity
Organization

Contact information

Practice address
983 COUNTY ROAD 2095 # 247, LIBERTY, TX 77575-8054
(936) 776-2094
Mailing address
983 COUNTY ROAD 2095 # 247, LIBERTY, TX 77575-8054
(936) 776-2094

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
08/26/2015
Last updated
08/26/2015
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