Individual provider · Type 1 NPI
John Wallace
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Ralston, NE
Practice location
6732 S 73rd Street Cir
Ralston, NE 68127-4387
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
Other intellectual and/or developmental disabilities community based residential treatment facility providers in Ralston
About NPI 1053126706
John Wallace's National Provider Identifier is 1053126706, issued on Feb 10, 2025. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Ralston, NE. The record was last updated on Feb 11, 2025.