NPIMap

Organization Active NPI

Tri-County Behavioral Healthcare

  • Intellectual Disabilities Intermediate Care Facility
  • Cleveland, TX
National Provider Identifier
1114943453
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
TRI-COUNTY BEHAVIORAL HEALTHCARE
Practice address
206 Charles Barker Ave
Cleveland, TX 77327-4711
Phone
(936) 521-6100
NPI assigned
Jul 13, 2006
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Evan Roberson
Title
Executive Director
Phone
(936) 521-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

206 Charles Barker Ave
Cleveland, TX 77327-4711

Mailing address

PO Box 3067
Conroe, TX 77305-3067
Phone (936) 521-6100

Other identifiers 1

IdentifierTypeStateIssuer
000389101MedicaidTX

Other names 1

  • Legion Street House Other name

National Provider Directory

National Provider Directory
Tax ID family
Tri County MHMR16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1114943453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3067",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773053067",
            "telephone_number": "936-521-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 CHARLES BARKER AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274711",
            "telephone_number": "936-521-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY BEHAVIORAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "936-521-6100"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000389101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legion Street House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cleveland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.