Organization
MAINSTREAM HABILITATION SERVICES OF TEXAS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA ANN SMITH MBA (DIRECTOR OF OPERATIONS)
(940) 552-2979
Entity
Organization
Contact information
Practice address
717 MOUNTAIN RIDGE CT W, LAKESIDE, TX 76135-4925
(817) 237-8329
(817) 238-9606
Mailing address
PO BOX 1677, 1728 PEASE STREET, VERNON, TX 76385-1677
(940) 552-2979
(940) 552-2987
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
112011
TX
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
116454
TX
315P00000X
Intellectual Disabilities Intermediate Care Facility
116726
TX
315P00000X
Intellectual Disabilities Intermediate Care Facility
116728
TX
Other
Enumeration date
05/02/2006
Last updated
08/22/2020
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