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General NPI Number Information
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NPI Number | 1083233498
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Entity Type | Organization
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Legal Business Name | THE POLO GROUP LLC
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 1626 W HIGHWAY 287 BUSINESS STE 101
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City | WAXAHACHIE
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State | TX
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Zip | 75165-4728
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Country | US
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Telephone | 972-906-9112
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Fax | 972-906-9112
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Provider Business Mailing Address
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Address Line | 1626 W HIGHWAY 287 BUSINESS STE 101
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City | WAXAHACHIE
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State | TX
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Zip | 75165-4728
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Country | US
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Telephone | 972-906-9112
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Fax | 972-906-9112
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Authorized Official
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Title or Position | CEO
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Name | LILLIAM POLO
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Credential | LCDC
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Telephone | 972-906-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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