Individual
MISS MARY ANN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
803 OAKDALE AVE, LONGVIEW, TX 75602-2049
(903) 917-3118
(903) 295-5856
Mailing address
803 OAKDALE AVE, LONGVIEW, TX 75602-2049
(903) 917-3118
(903) 295-5856
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
00238902
TX
320700000X
Physical Disabilities Residential Treatment Facility
00238902
TX
Other
Enumeration date
10/11/2011
Last updated
10/11/2011
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