NPIMap

Organization Active NPI

Pecan Valley MHMR Region

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mineral Wells, TX
National Provider Identifier
1043438153
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
394602 Issued in TX
Legal business name
PECAN VALLEY MHMR REGION
Practice address
202 NW 23Rd St
Mineral Wells, TX 76067-2998
Phone
(940) 325-1942
NPI assigned
Apr 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ralph Whaite
Title
Mis Director
Phone
(940) 397-3147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 394602 TX Primary

Addresses

Primary practice location

202 NW 23Rd St
Mineral Wells, TX 76067-2998

Mailing address

650 W Green St
Stephenville, TX 76401-3311
Phone (254) 965-7806

Other names 1

  • 23rd Street Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043438153. Details of each certification follow.

  • CCN 45G262 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45G262

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
NORTHWEST 23RD STREET
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 2, 1987
Last certification
Dec 17, 2024
Beds
6
Ownership / control type
County
Facility address
202 NW 23Rd St
Mineral Wells, TX 76067

National Provider Directory

National Provider Directory
Tax ID family
Pecan Valley MHMR Region23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

202 NW 23rd St
Mineral Wells, TX 76067
Phone (940) 325-1942

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043438153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W GREEN ST",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764013311",
            "telephone_number": "254-965-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 NW 23RD ST",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760672998",
            "telephone_number": "940-325-1942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN VALLEY MHMR REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHAITE",
        "authorized_official_first_name": "RALPH",
        "authorized_official_title_or_position": "MIS DIRECTOR",
        "authorized_official_telephone_number": "940-397-3147"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TX",
            "license": "394602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "23rd Street",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mineral Wells, TX

Sources for this page

Verify at the official NPI Registry.