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General NPI Number Information
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NPI Number | 1740771195
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Entity Type | Organization
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Legal Business Name | RIVERWALK RANCH, LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 6960 DICK PRICE ROAD
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 817-720-9520
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Fax |
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Provider Business Mailing Address
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Address Line | 6960 DICK PRICE ROAD
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 850-491-4993
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN R JANEIRO
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Credential |
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Telephone | 817-720-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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