1639232002 NPI number — SABINE VALLEY REGIONAL MHMR CENTER

Table of content: (NPI 1639232002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639232002 NPI number — SABINE VALLEY REGIONAL MHMR CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SABINE VALLEY REGIONAL MHMR 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:
6
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:
1639232002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75608-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-758-2471
Provider Business Mailing Address Fax Number:
903-234-1639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 WOODBINE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75601-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-758-2471
Provider Business Practice Location Address Fax Number:
903-234-1639
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VILLARREAL
Authorized Official First Name:
ROSEMARY
Authorized Official Middle Name:
O
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
903-234-4226

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084B0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00BM15 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137921601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137921602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137921606 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137921607 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137921608 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129201 . This is a "SUPERIOR HEALTH PLAN CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CB6459 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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