MEDICARE: GLOW OF HAPPINESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1528330594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOW OF HAPPINESS

Provider Business Mailing Address
First Line	:	200 W STATE HIGHWAY 6
Second Line	:	SUIT 211
City	:	WACO
State	:	TX
Zip	:	76712-7923
Country	:	US
Telephone Number	:	254-981-6351
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W STATE HIGHWAY 6
Second Line	:	SUIT 211
City	:	WACO
State	:	TX
Zip	:	76712-7923
Country	:	US
Telephone Number	:	254-981-6351
Fax Number	:

Authorized Official
Title or Position	:	CEO-CO-FOUNDER
Name	:	MS. SONIA FUENTES
Credential	:
Telephone Number	:	254-981-6351

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	02/06/2012

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Directions to “GLOW OF HAPPINESS ” Practice Location

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