Provider Demographics
NPI:1245325760
Name:RONNIE WELLS
Entity type:Organization
Organization Name:RONNIE WELLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-419-6015
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-0456
Mailing Address - Country:US
Mailing Address - Phone:936-419-6015
Mailing Address - Fax:
Practice Address - Street 1:1105 WEST WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868
Practice Address - Country:US
Practice Address - Phone:936-870-3311
Practice Address - Fax:936-870-3321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONNIE WELLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child