Breckenridge Village

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

BRECKENRIDGE VILLAGE

Doing business as

Breckenridge Village Mallard House

Practice address

15062 County Road 1145
Tyler, TX 75704-7516

Phone

(903) 956-8100

Fax

(903) 596-8104

NPI assigned

Sep 27, 2007

Last updated

Aug 26, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

BAPTIST CHILD & FAMILY SERVICES INC.As reported in NPPES

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

Authorized official

Name

Kevin King

Title

Executive Director

Phone

(903) 896-8100

Specialties & licenses 1

Addresses

Other names 1

• Breckenridge Village Mallard House Doing business as

Tax ID family

Baptist Care Facilities for Person's With Mental Disabilties3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Baptist Care Facilities for Person's With Mental Disabilties

  dba Breckenridge Village of Tyler

  • Assisted Living Facility
  • Tyler, TX
  • NPI 1770969768
  NPD tax ID
• Breckenridge Village

  dba Breckenridge Village of Tyler

  • Intellectual Disabilities Intermediate Care Facility
  • Tyler, TX
  • NPI 1477748010
  NPD tax ID

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1245427947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15062 COUNTY ROAD 1145",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757047516",
            "telephone_number": "903-956-8100",
            "fax_number": "903-596-8104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15062 COUNTY ROAD 1145",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757047516",
            "telephone_number": "903-956-8100",
            "fax_number": "903-596-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECKENRIDGE VILLAGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST CHILD & FAMILY SERVICES INC.",
        "enumeration_date": "2007-09-27",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "903-896-8100"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Breckenridge Village Mallard House",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Breckenridge Village Mallard House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bratcher Chiropractic Diagnostic Center PC (Bratcher Chiropractic)
• Bratcher Injury & Wellness Center, P.a.
• Luther Burbank Bratcher, D.C.
• William Xavier Bratcher
• Rebekah Brazell
• Breckenridge Village (Breckenridge Village of Tyler)
• Brent T Alford MD PA
• Lesle Jo Brewer, CST
• Norma Brewer
• Tonieh Brewer

• Intellectual Disabilities Intermediate Care Facility in Tyler, TX
• Providers in Tyler, TX by specialty
• Intellectual Disabilities Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.