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General NPI Number Information
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NPI Number | 1962779462
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Entity Type | Organization
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Legal Business Name | THE RETREAT RESIDENTIAL CARE HOME
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 2518 HELENA CIR
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City | ABILENE
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State | TX
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Zip | 79606-3425
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Country | US
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Telephone | 325-370-7263
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Fax |
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Provider Business Mailing Address
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Address Line | 1966 MATADOR ST
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City | ABILENE
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State | TX
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Zip | 79605-5208
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Country | US
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Telephone | 325-370-7263
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRITTANY CHRISTINE GRACE
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Credential | RN
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Telephone | 325-370-7263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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