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General NPI Number Information
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NPI Number | 1124834668
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Entity Type | Organization
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Legal Business Name | ZACHARY'S HOUSE, LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 3315 FM 523 RD
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City | FREEPORT
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State | TX
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Zip | 77541-6616
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Country | US
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Telephone | 346-287-8938
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 FM 523 RD
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City | FREEPORT
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State | TX
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Zip | 77541-6616
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Country | US
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Telephone | 346-287-8938
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Fax |
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Authorized Official
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Title or Position | LICENSED CHILDCARE ADMINISTRATOR
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Name | CLIFFORD WAYNE ROBERTSON JR.
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Credential | LCCA
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Telephone | 979-203-6470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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