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General NPI Number Information
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NPI Number | 1518772888
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Entity Type | Organization
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Legal Business Name | STONEWALL COMMUNITY CENTER
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 16400 W STATE HIGHWAY 21
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City | DOUGLASS
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State | TX
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Zip | 75943-3901
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Country | US
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Telephone | 936-219-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 16400 W STATE HIGHWAY 21
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City | DOUGLASS
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State | TX
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Zip | 75943-3901
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Country | US
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Telephone | 936-219-4611
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | MR. DESMOND TOLBERT
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Credential |
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Telephone | 936-219-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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