PRAIRIE HARBOR, LLC – NPI #1235565797
Residential Treatment Facility, Emotionally Disturbed Children

A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

PRAIRIE HARBOR, LLC is a residential treatment facility located in WALLIS, TX. NPPES has assigned the NPI number 1235565797 to PRAIRIE HARBOR, LLC on September 16, 2013. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 322D00000X from the Health Care Provider Taxonomy code set, which is classified as Residential Treatment Facility, Emotionally Disturbed Children.

The NPI profile was previously updated about 12 years ago on Feb 28, 2014. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PRAIRIE HARBOR, LLC below.

NPI Profile for
PRAIRIE HARBOR, LLC

NPI Number
1235565797
Enumeration Date

(more than 12 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PRAIRIE HARBOR, LLC
Primary location
7146 HIGHWAY 60
WALLIS, TX 77485-9507
Phone: (979) 217-1581 Fax:
Mailing address
PO BOX 517
WALLIS, TX 77485-0517
Phone: Fax:
Organization Subpart
No
Authorized Official
RANDALL BRYANT
EXECUTIVE DIRECTOR
Phone: (979) 217-1581
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
322D00000X
- Residential Treatment Facility, Emotionally Disturbed Children (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.