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120 David Wade Drive Victoria TX 77905 | |
| (361) 575-8271 | |
| (361) 575-6520 |
| Full Name | |
|---|---|
| Speciality | Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
| Location | 120 David Wade Drive, Victoria, Texas |
| Authorized Official Name and Position | Pamela E. Helm (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2813351000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2666 Victoria TX 77902-2666 Ph: (361) 575-8271 | 120 David Wade Drive Victoria TX 77905 Ph: (361) 575-8271 |
| NPI Number | 1609958628 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 07/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609958628 | NPI | - | NPPES |
| 112748201 | Medicaid | TX | |
| 112748202 | Medicaid | TX |
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