Organization · Type 2 NPI

Wallace Place In the Pines

Mental Illness Community Based Residential Treatment Facility · Livingston, TX

NPI number 1194382374 Active

Practice location

1706 Davis Ave
Livingston, TX 77351-2004

Specialties and licenses

Taxonomy	Code	License
Poetry Therapist	102X00000X	None listed
Mental Illness Community Based Residential Treatment Facility Primary	320800000X	None listed
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	320900000X	None listed
Emotionally Disturbed Childrens' Residential Treatment Facility	322D00000X	None listed
Psychiatric Residential Treatment Facility	323P00000X	None listed
Child Intellectual and/or Developmental Disabilities Respite Care	385HR2060X	None listed

Mental Illness Community Based Residential Treatment Facility: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

NPI record

NPI: 1194382374
Entity type: Organization (Type 2)
Issued: May 23, 2019
Last updated: Jun 4, 2019
Status: Active

Other names

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Wallace Place In the Pines · former legal business name
Wallace Place In the Pines · former legal business name

Authorized official

Barbara Ann Wallace
Owner
(936) 662-5617

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1194382374

Wallace Place In the Pines's National Provider Identifier is 1194382374, issued on May 23, 2019. The primary taxonomy on file is Mental Illness Community Based Residential Treatment Facility (320800000X), and the practice location is in Livingston, TX. The record was last updated on Jun 4, 2019.