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General NPI Number Information
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NPI Number | 1811204811
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Entity Type | Organization
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Legal Business Name | JENNINGS PLACE INC.
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 614 COUNTY ROAD 2230
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City | CENTER
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State | TX
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Zip | 75935-6177
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Country | US
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Telephone | 936-572-8153
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Fax | 936-275-9732
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Provider Business Mailing Address
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Address Line | 614 COUNTY ROAD 2230
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City | CENTER
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State | TX
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Zip | 75935-6177
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Country | US
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Telephone | 936-572-8153
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Fax | 936-275-9732
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VANESSA LOLITA DAVIS
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Credential | N/A
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Telephone | 936-572-8153
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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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