| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3416 Hillcrest Dr, Waco, Texas |
| Authorized Official Name and Position | Matt Kuhlman (CEO) |
| Authorized Official Contact | 7132669944 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 4785 Msc 675 Houston TX 77210 Ph: (713) 266-9944 | 3416 Hillcrest Dr Waco TX 76708 Ph: (254) 224-8880 |
| NPI Number | 1366535023 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 11/09/2020 |
| Certification Date | 11/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366535023 | NPI | - | NPPES |
| 0655219-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 316-3542 (Texas) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
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