Provider Demographics
NPI:1629316765
Name:WHEAT MISSION IN TEXAS
Entity Type:Organization
Organization Name:WHEAT MISSION IN TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-561-9826
Mailing Address - Street 1:1611 N INTERSTATE 35E
Mailing Address - Street 2:#410
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 N INTERSTATE 35E
Practice Address - Street 2:#410
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3885
Practice Address - Country:US
Practice Address - Phone:682-561-9826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services