Organization
ACCESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLYN LANG (EXECUTIVE DIRECTOR)
(903) 586-5507
Entity
Organization
Contact information
Practice address
5656 N. JACKSON, JACKSONVILLE, TX 75766
(903) 589-9000
(903) 586-9200
Mailing address
5656 N. JACKSON, JACKSONVILLE, TX 75766
(903) 589-9000
(903) 586-9200
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
45H262
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45H262
—
TX
Enumeration date
06/29/2006
Last updated
06/13/2008
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