Provider Demographics
NPI:1417174178
Name:BOB WILSON MINISTRIES
Entity Type:Organization
Organization Name:BOB WILSON MINISTRIES
Other - Org Name:MEADOWS HOUSE RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:ELTON
Authorized Official - Last Name:BRAWNER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:254-471-5709
Mailing Address - Street 1:2114 BIRDCREEK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1020
Mailing Address - Country:US
Mailing Address - Phone:254-742-2211
Mailing Address - Fax:254-742-2245
Practice Address - Street 1:6585 S FM 183
Practice Address - Street 2:
Practice Address - City:EVANT
Practice Address - State:TX
Practice Address - Zip Code:76525
Practice Address - Country:US
Practice Address - Phone:254-471-5709
Practice Address - Fax:254-471-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2526A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility