1467463042 NPI number — NUECES COUNTY MENTAL HEALTH & MENTAL RETARDATION COMMUNITY CTR.

Table of content: (NPI 1467463042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467463042 NPI number — NUECES COUNTY MENTAL HEALTH & MENTAL RETARDATION COMMUNITY CTR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUECES COUNTY MENTAL HEALTH & MENTAL RETARDATION COMMUNITY CTR.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NUECES CENTER FOR MENTAL HEALTH AND INTELLECTUAL DISABILITIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467463042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78467-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-886-6900
Provider Business Mailing Address Fax Number:
361-886-1379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3733 S PORT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78415-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-886-6900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRIX
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY CEO
Authorized Official Telephone Number:
361-886-6900

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 138305113 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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