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General NPI Number Information
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NPI Number | 1821597139
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Entity Type | Organization
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Legal Business Name | EDDIE'S REACHING OUT RESIDENTIAL CORPORATION
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 338 BOND ST
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City | LONE STAR
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State | TX
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Zip | 75668-0230
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Country | US
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Telephone | 903-646-3171
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Fax | 903-656-0512
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | LONE STAR
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State | TX
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Zip | 75668-0124
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Country | US
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Telephone | 903-646-3171
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Fax | 903-656-0512
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MR. EDDIE J JOHNSON
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Credential |
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Telephone | 903-646-3171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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