Provider Demographics
NPI:1295382190
Name:METAMORPHOSIS CLIENT CARE CENTER, LLC
Entity Type:Organization
Organization Name:METAMORPHOSIS CLIENT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:WEATHERSPOON
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-400-6550
Mailing Address - Street 1:9066 HINES CIR
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:TX
Mailing Address - Zip Code:76035-1106
Mailing Address - Country:US
Mailing Address - Phone:682-400-6550
Mailing Address - Fax:
Practice Address - Street 1:9066 HINES CIR
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:TX
Practice Address - Zip Code:76035-1106
Practice Address - Country:US
Practice Address - Phone:682-400-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-25
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities