NPIMap

Organization Active NPI

Pecan Valley MHMR Region

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Granbury, TX
National Provider Identifier
1144590159
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
3492-3494 Issued in TX
Legal business name
PECAN VALLEY MHMR REGION
Practice address
104 Pirate Dr
Granbury, TX 76048-5682
Phone
(817) 573-5012
Fax
(817) 579-9253
NPI assigned
Jan 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

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

Authorized official

Name
Mr. Coke Beatty
Title
Executive Director
Phone
(817) 579-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 3492-3494 TX Primary

Addresses

Primary practice location

104 Pirate Dr
Granbury, TX 76048-5682

Mailing address

PO Box 729
Granbury, TX 76048-0729
Phone (817) 579-4400

Other names 1

  • Pecan Valley Centers for Behavioral and Developmental Healthcare Doing business as

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

NPI Registry JSON

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1144590159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760480729",
            "telephone_number": "817-579-4400",
            "fax_number": "817-579-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 PIRATE DR",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760485682",
            "telephone_number": "817-573-5012",
            "fax_number": "817-579-9253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN VALLEY MHMR REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-06",
        "last_updated": "2012-01-06",
        "status": "A",
        "authorized_official_last_name": "BEATTY",
        "authorized_official_first_name": "COKE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "817-579-4400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TX",
            "license": "3492-3494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pecan Valley Centers for Behavioral and Developmental Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granbury, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; 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.