Est 400 of Waco LLC

NPI #1033554837 in Waco, Texas

Provider Information

NPI Number: 1033554837
Entity Type: Organization
Organization Name: Est 400 of Waco LLC
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: May 7, 2013
Last Updated: May 7, 2013

Practice Location

Address: 4555 LAKE SHORE DR
City: Waco
State: Texas
ZIP Code: 76710-1814
Phone: (254) 776-0400

Authorized Official

Name: RUBY C SANTIBANEZ
Title: BUSINESS/OFFICE MANAGER
Phone: (254) 776-0400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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