1588661060 NPI number — PADRE BEHAVIORAL HEALTH SYSTEM, LLC

Table of content: (NPI 1588661060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588661060 NPI number — PADRE BEHAVIORAL HEALTH SYSTEM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PADRE BEHAVIORAL HEALTH SYSTEM, LLC
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:
Provider Other Organization Name Type Code:
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:
1588661060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6629 WOOLDRIDGE RD
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:
78414-2909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-986-9444
Provider Business Mailing Address Fax Number:
361-986-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6629 WOOLDRIDGE RD
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:
78414-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-986-9444
Provider Business Practice Location Address Fax Number:
361-986-1897
Provider Enumeration Date:
06/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROLEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
SEWELL
Authorized Official Title or Position:
CEO-CFO
Authorized Official Telephone Number:
361-986-9444

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  007165 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HH3978 . This is a "BCBS CD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0978 . This is a "BCBS PSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH6788 . This is a "BCBS PARTIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".