PECAN VALLEY MHMR REGION NPI 1467672378

NPI Information

NPI: 1467672378
Provider Name: PECAN VALLEY MHMR REGION

Other Name: QUAIL PARK

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
805 QUAIL PARK LN
CLEBURNE, TX
ZIP 76031
Phone: (817) 558-0751
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PECAN VALLEY MHMR REGION is a community based residential treatment facility, intellectual and/or developmental disabilities in Cleburne, TX. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. PECAN VALLEY MHMR REGION NPI is 1467672378. The provider is registered as an organization entity type.
The provider Other Name Is Quail Park.

The provider's business location address is:

805 QUAIL PARK LN
CLEBURNE, TX
ZIP 76031-731
Phone: (817) 558-0751

The provider's authorized official is Ralph Whaite .
The authorized official title is Mis Director and has the following contact phone number (940) 397-3147.

The enumeration date for this NPI number is 4/26/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		1014218	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1014218	OTHER		DADS CONTRACT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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