Organization
STEPHEN M WALLACH HCS PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN M WALLACH (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(817) 329-5085
Entity
Organization
Contact information
Practice address
1701 W NORTHWEST HWY, SUITE 100, GRAPEVINE, TX 76051-8127
(817) 329-5085
(817) 329-5084
Mailing address
1701 W NORTHWEST HWY, SUITE 100, GRAPEVINE, TX 76051-8127
(817) 329-5085
(817) 329-5084
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
NA
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88R
DADS HCS COMPONENT CODE
TX
Enumeration date
06/18/2006
Last updated
08/22/2020
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