| Shiloh Treatment Center, Inc. | |
|
4774 Del Bello Rd Manvel TX 77578 | |
| (281) 489-1290 | |
| (281) 489-0167 |
| Full Name | Shiloh Treatment Center, Inc. |
|---|---|
| Speciality | Psychiatric Residential Treatment Facility |
| Location | 4774 Del Bello Rd, Manvel, Texas |
| Authorized Official Name and Position | Luis A Valdes (ADMINISTRATOR) |
| Authorized Official Contact | 2814891290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiloh Treatment Center, Inc. Po Box 84469 Pearland TX 77584-0011 Ph: (281) 489-1290 | Shiloh Treatment Center, Inc. 4774 Del Bello Rd Manvel TX 77578 Ph: (281) 489-1290 |
| NPI Number | 1992877948 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 11/01/2023 |
| Certification Date | 10/30/2023 |
| Medicare PECOS PAC ID | 5395732143 |
|---|---|
| Medicare Enrollment ID | O20040426001265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992877948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 323P00000X | Psychiatric Residential Treatment Facility | TDFPS517689 (Texas) | Primary |
| Provider Name | Lance Dee Carroll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619050952 PECOS PAC ID: 1456320886 Enrollment ID: I20041001000094 |
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