Shacklefree Ministries

NPI #1356695480 in Longview, Texas

Provider Information

NPI Number: 1356695480
Entity Type: Organization
Organization Name: Shacklefree Ministries
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Oct 26, 2012
Last Updated: Oct 26, 2012

Practice Location

Address: 409 N FREDONIA ST
Address 2: SUITE 116
City: Longview
State: Texas
ZIP Code: 75601-6466
Phone: (903) 917-6632

Authorized Official

Name: MRS. VIRGINIA LEA TAYLOR, BCLBT
Title: CHRISTIAN COUNSELOR
Phone: (903) 917-6632

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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