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General NPI Number Information
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NPI Number | 1760610406
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Entity Type | Organization
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Legal Business Name | BE OF AMERICA - TEXAS SERVICES, LLC
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 700 RANCHO GRANDE DR
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City | WIMBERLEY
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State | TX
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Zip | 78676-5896
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Country | US
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Telephone | 512-216-7502
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Fax | 512-847-0781
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Provider Business Mailing Address
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Address Line | PO BOX 1694
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City | WIMBERLEY
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State | TX
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Zip | 78676-1694
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Country | US
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Telephone | 512-216-7502
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Fax | 512-847-0781
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. M. ELENA ROGERS-BILGER
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Credential | MSSW
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Telephone | 512-216-7502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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