Healthcare Provider Details

I. General information

NPI: 1992005078
Provider Name (Legal Business Name): ALL SAINTS CAMP AND CONFERENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2010
Last Update Date: 10/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 STANTON WAY
POTTSBORO TX
75076-6183
US

IV. Provider business mailing address

418 STANTON WAY
POTTSBORO TX
75076-6183
US

V. Phone/Fax

Practice location:
  • Phone: 903-786-3148
  • Fax:
Mailing address:
  • Phone: 903-786-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number091005
License Number StateTX

VIII. Authorized Official

Name: CHRISTINE TOKARZ
Title or Position: DIRECTOR
Credential:
Phone: 903-786-3148