Provider Demographics
NPI:1073897633
Name:SUNNY GLEN CHILDREN'S HOME INC.
Entity Type:Organization
Organization Name:SUNNY GLEN CHILDREN'S HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SOCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC-S, LCCA
Authorized Official - Phone:956-399-5356
Mailing Address - Street 1:2385 W EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-7831
Mailing Address - Country:US
Mailing Address - Phone:956-399-5356
Mailing Address - Fax:956-399-3634
Practice Address - Street 1:2385 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-7769
Practice Address - Country:US
Practice Address - Phone:956-399-5356
Practice Address - Fax:956-399-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health