Organization
GULF BEND MRMR CENTER ICF/MR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD L POLZIN (EXECUTIVE DIRECTOR)
(361) 575-0611
Entity
Organization
Contact information
Practice address
102 BURNET ST, PORT LAVACA, TX 77979-2611
(361) 575-0611
(361) 582-2329
Mailing address
1502 E AIRLINE RD, SUITE 25, VICTORIA, TX 77901-4112
(361) 575-0611
(361) 582-2329
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/04/2006
Last updated
08/22/2020
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