Organization
RUBY JEWELLS LEGACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANIQUA BLAKELY (OWNER/PROGRAM MANAGER)
(989) 714-6562
Entity
Organization
Contact information
Practice address
3007 LOMBARD DR, WICHITA FALLS, TX 76309-4727
(989) 714-6562
Mailing address
3007 LOMBARD DR, WICHITA FALLS, TX 76309-4727
(989) 714-6562
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/20/2018
Last updated
02/12/2024
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