Est 400 of Waco LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EST 400 OF WACO LLC

Doing business as

Lake Shore Center for Behavioral Health

Practice address

4555 Lake Shore Dr
Waco, TX 76710-1814

Phone

(254) 776-0400

Fax

(254) 776-0637

NPI assigned

May 7, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ruby C Santibanez

Title

Business/Office Manager

Phone

(254) 776-0400

Specialties & licenses 1

Addresses

Other names 1

• Lake Shore Center for Behavioral Health Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1033554837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767101814",
            "telephone_number": "254-776-0400",
            "fax_number": "254-776-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767101814",
            "telephone_number": "254-776-0400",
            "fax_number": "254-776-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EST 400 OF WACO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "SANTIBANEZ",
        "authorized_official_first_name": "RUBY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BUSINESS/OFFICE MANAGER",
        "authorized_official_telephone_number": "254-776-0400"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Shore Center for Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ariana Espinosa Grimaldo
• Danae Espinoza
• Christine Clata Espiritu, OTR/L
• Paul Goodman Espy, M.D.
• Stephanie Essary, PHARM.D.
• Morgan J Estes, CNM
• Esthers Hands Therapeutic Services, LLC
• Krystal Ann Estrada, MD
• Ethelred Enterprises, LLC.
• Sarah Etheridge

• Mental Health Clinic/Center (Including Community Mental Health Center) in Waco, TX
• Providers in Waco, TX by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.