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Organization Active NPI

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  • Intellectual Disabilities Intermediate Care Facility
  • Bryan, TX
National Provider Identifier
1144422932
Registry record updated Mar 26, 2024
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Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
7662 Issued in TX
Legal business name
FAMILY TREE
Practice address
408 N Washington Ave
Bryan, TX 77803-5310
Phone
(979) 822-6467
Fax
(979) 821-9448
NPI assigned
Jun 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Bill Kelly
Title
Executive Director
Phone
(979) 822-6467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 7662 TX Primary

Addresses

Primary practice location

408 N Washington Ave
Bryan, TX 77803-5310

Mailing address

1504 Texas Ave.
P.O. Box 4588
Bryan, TX 77805-4588
Phone (979) 822-6467

Other identifiers 1

IdentifierTypeStateIssuer
000766201MedicaidTX

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 1144422932. Details of each certification follow.

  • CCN 45G020 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45G020

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
FAMILY TREE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 22, 1983
Last certification
Jul 24, 2025
Beds
8
Ownership / control type
Private (non-profit)
Facility address
408 N Washington Ave
Bryan, TX 77803

National Provider Directory

National Provider Directory
Tax ID family
Mhmra of Brazos Valley5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1144422932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 TEXAS AVE.",
            "address_2": "P.O. BOX 4588",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778054588",
            "telephone_number": "979-822-6467",
            "fax_number": "979-821-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N WASHINGTON AVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778035310",
            "telephone_number": "979-822-6467",
            "fax_number": "979-821-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY TREE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "979-822-6467"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "7662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000766201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.