Provider Demographics
NPI:1700154887
Name:LIBBIES PLACE
Entity Type:Organization
Organization Name:LIBBIES PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LBSW
Authorized Official - Phone:409-741-2538
Mailing Address - Street 1:2803 53RD ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-5914
Mailing Address - Country:US
Mailing Address - Phone:409-741-2538
Mailing Address - Fax:409-744-2437
Practice Address - Street 1:5402 AVENUE U
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-5810
Practice Address - Country:US
Practice Address - Phone:409-741-2538
Practice Address - Fax:409-744-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127840261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care