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Cindy Johnson Kendrasha Gray
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Longview, Texas
NPI 1720590870

Cindy Johnson Kendrasha Gray is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Longview, TX. Cindy Johnson Kendrasha Gray practices in Longview, TX. The NPI Number for Cindy Johnson Kendrasha Gray is 1720590870 and holds a License No. (Texas).

The current practice location address for Cindy Johnson Kendrasha Gray is 801 S Mobberly Ave, Longview, TX and can be reached out via phone at 903-424-8343 and via fax at 903-424-8343.

Location: 801 S Mobberly Ave, Longview, TX, 75602-1303
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1720590870
Provider Name
Cindy Johnson Kendrasha Gray
Credential
Provider Entity Type
Organization
Address
801 S Mobberly Ave, Longview, TX, 75602-1303
Phone Number
903-424-8343
Fax Number
903-424-8343
Provider Enumeration Date
10/30/2017
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
801 S Mobberly Ave
City
Longview
State
Texas
Zip
75602-2037
Phone Number
903-424-8343
Fax Number
903-424-8343
person
Provider Business Mailing Address Details
Address
801 S Mobberly Ave
City
Longview
State
Texas
Zip
75602-2037
Phone Number
903-424-8343
Fax Number
903-424-8343
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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