Est 400 Of Waco LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Waco, TX. Organization (NPI-2).
NPI number1033554837
StatusActive
Last updated in NPPESMay 7, 2013
Details
- NPI
- 1033554837
- Entity type
- Organization (NPI-2)
- Legal business name
- Est 400 Of Waco LLC
- Organization subpart
- No
- Enumeration date
- May 7, 2013
- Last updated
- May 7, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Other names
- Lake Shore Center For Behavioral Health (Doing Business As)
Practice location
4555 Lake Shore DrWaco, TX 76710-1814
Phone 254-776-0400 · Fax 254-776-0637
Mailing address
4555 Lake Shore DrWaco, TX 76710-1814
Phone 254-776-0400 · Fax 254-776-0637
Authorized official
Ruby C Santibanez
Business/Office Manager
2547760400
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