Provider Demographics
NPI:1235792599
Name:SACRED HOLISTIC PATH SANCTUARY REFUGE INCORPORATED
Entity Type:Organization
Organization Name:SACRED HOLISTIC PATH SANCTUARY REFUGE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOBERT
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:903-732-6271
Mailing Address - Street 1:P.O. BOX 9636
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711
Mailing Address - Country:US
Mailing Address - Phone:936-645-9939
Mailing Address - Fax:
Practice Address - Street 1:15360 FM 850
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-3916
Practice Address - Country:US
Practice Address - Phone:936-645-9939
Practice Address - Fax:903-253-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17799986OtherPRIVATE INSURANCE