Provider Demographics
NPI:1962779462
Name:THE RETREAT RESIDENTIAL CARE HOME
Entity type:Organization
Organization Name:THE RETREAT RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-370-7263
Mailing Address - Street 1:1966 MATADOR ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5208
Mailing Address - Country:US
Mailing Address - Phone:325-370-7263
Mailing Address - Fax:
Practice Address - Street 1:2518 HELENA CIR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3425
Practice Address - Country:US
Practice Address - Phone:325-370-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency