Healthcare Provider Details

I. General information

NPI: 1699154609
Provider Name (Legal Business Name): YVONNE PETERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MISTY BROOK DR APT 100
ARLINGTON TX
76013-5197
US

IV. Provider business mailing address

905 MISTY BROOK DR APT 100
ARLINGTON TX
76013-5197
US

V. Phone/Fax

Practice location:
  • Phone: 817-566-3300
  • Fax:
Mailing address:
  • Phone: 817-566-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. YVONNE DENELL PETERS
Title or Position: OWNER
Credential:
Phone: 817-566-3300