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General NPI Number Information
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NPI Number | 1710970397
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH SERVICES OF WACO
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 301 LONDONDERRY DR
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City | WACO
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State | TX
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Zip | 76712-7915
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Country | US
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Telephone | 254-776-5970
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Fax | 254-751-4887
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Provider Business Mailing Address
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Address Line | PO BOX 2589
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City | WACO
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State | TX
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Zip | 76702-2589
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Country | US
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Telephone | 254-776-5970
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Fax | 254-751-4887
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Authorized Official
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Title or Position | SENIOR VP, CFO
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Name | MRS. KAREN A RICHARDSON
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Credential |
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Telephone | 254-751-4172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 000736
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License Number State | TX
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