Organization
PECAN VALLEY MHMR REGION
Active
Organization
PECAN VALLEY MHMR REGION
Active
Other names
Mill St.
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH WHAITE (MIS DIRECTOR)
(940) 397-3147
Entity
Organization
Contact information
Practice address
1212 S MILL ST, WEATHERFORD, TX 76086-5734
(817) 598-0559
Mailing address
650 W GREEN ST, STEPHENVILLE, TX 76401-3311
(254) 965-7806
(254) 965-4308
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
361001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
361001
DADS CONTRACT
TX
Enumeration date
04/23/2007
Last updated
08/22/2020
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