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General NPI Number Information
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NPI Number | 1467167866
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Entity Type | Organization
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Legal Business Name | CEAETTAS FAMILY SERVICES , LLC
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 215 COUNTY ROAD 746
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City | BUNA
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State | TX
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Zip | 77612-6333
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Country | US
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Telephone | 409-383-8399
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 793
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City | BUNA
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State | TX
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Zip | 77612-0793
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Country | US
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Telephone | 409-383-8399
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | CEAETTA HARRIS RENFRO
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Credential |
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Telephone | 409-383-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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