Provider Demographics
NPI:1497020895
Name:HELEN FARABEE REGIONAL CENTERS
Entity Type:Organization
Organization Name:HELEN FARABEE REGIONAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-397-3147
Mailing Address - Street 1:1000 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 WILBARGER ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4564
Practice Address - Country:US
Practice Address - Phone:940-553-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2464-3510261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder