1154405371 NPI number — HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER

Table of content: (NPI 1154405371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154405371 NPI number — HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER
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:
1154405371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S 12TH ST
Provider Second Line Business Mailing Address:
P O BOX 890
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76701-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-752-3451
Provider Business Mailing Address Fax Number:
254-752-7421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 JANE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROESBECK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76642-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-729-5450
Provider Business Practice Location Address Fax Number:
254-729-8451
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
254-752-3451

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , 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: 000715801 . This is a "VENDOR #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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