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General NPI Number Information
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NPI Number | 1629316765
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Entity Type | Organization
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Legal Business Name | WHEAT MISSION IN TEXAS
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 1611 N INTERSTATE 35E #410
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City | CARROLLTON
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State | TX
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Zip | 75006-3885
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Country | US
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Telephone | 682-561-9826
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 N INTERSTATE 35E #410
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City | CARROLLTON
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State | TX
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Zip | 75006-3885
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEAGUN LEE
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Credential |
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Telephone | 682-561-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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