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NPI 1013945625 · Intellectual Disabilities Intermediate Care Facility · Jacksonville, TX
Provider details
- NPI number
- 1013945625
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Allyn Lang, Executive Director(903) 586-5507
- License
- 45H268 (TX)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
5656 N. Jackson
Jacksonville, TX 75766
Phone: (903) 589-9000
Fax: (903) 586-9200
Approximate (ZIP-level) locationGet directions
Mailing address
5656 N. Jackson
Jacksonville, TX 75766
Registry dates
- Enumerated
- 2006-06-30
- Last updated
- 2008-06-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.