Organization
EAST TEXAS COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC.
Active
Other names
Roosevelt Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. D. MICHAEL JOHNSON (PRESIDENT)
(409) 385-2626
Entity
Organization
Contact information
Practice address
1020 ROOSEVELT DR, SILSBEE, TX 77656-3408
(409) 385-3723
(409) 385-9304
Mailing address
PO BOX 2185, SILSBEE, TX 77656-2185
(409) 385-2626
(409) 385-9307
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
7554
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7554
VENDOR
TX
Enumeration date
02/20/2007
Last updated
08/22/2020
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