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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