Prairie Harbor, LLC

NPI #1235565797 in Wallis, Texas

Provider Information

NPI Number: 1235565797
Entity Type: Organization
Organization Name: Prairie Harbor, LLC
Primary Specialty: Residential Treatment Facility, Emotionally Disturbed Children
Enumeration Date: Sep 16, 2013
Last Updated: Feb 28, 2014

Practice Location

Address: 7146 HIGHWAY 60
City: Wallis
State: Texas
ZIP Code: 77485-9507
Phone: (979) 217-1581

Authorized Official

Name: RANDALL BRYANT
Title: EXECUTIVE DIRECTOR
Phone: (979) 217-1581

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Emotionally Disturbed Children	322D00000X	Primary

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