Organization
U-NIQ IDENTITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD ROSS (CHEIF EXECUTIVE OFFICER)
(469) 901-0044
Entity
Organization
Contact information
Practice address
917 FORDHAM RD, DALLAS, TX 75216-6133
(469) 901-0044
Mailing address
917 FORDHAM RD, DALLAS, TX 75216-6133
(469) 901-0044
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/28/2015
Last updated
01/28/2015
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