Organization
CAMINO REAL COMMUNITY MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LOREN WILSON (REIMBURSEMENT OFFICER)
(210) 357-0300
Entity
Organization
Contact information
Practice address
19965 FM 3175 NORTH, LYTLE, TX 78052
(210) 357-0300
(210) 357-0458
Mailing address
PO BOX 725, LYTLE, TX 78052-0725
(210) 357-0300
(210) 357-0458
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/13/2006
Last updated
09/22/2020
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