Organization
IVY REIGN SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRANCE TOLIVER MASTER OF SCIENCE (PROGRAM DIRECTOR)
(254) 799-3200
Entity
Organization
Contact information
Practice address
4305 GRAM LN, WACO, TX 76705-2661
(254) 799-3200
(254) 799-3204
Mailing address
4305 GRAM LN, WACO, TX 76705-2661
(254) 799-3200
(254) 799-3204
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
001007980
TX
Other
Enumeration date
05/30/2007
Last updated
06/26/2008
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