NPIMap

Organization Active NPI

Gulf Bend MRMR Center HCS Program

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Victoria, TX
National Provider Identifier
1285668541
Registry record updated Aug 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
GULF BEND MRMR CENTER HCS PROGRAM
Practice address
6502 Nursery Dr
Suite 100
Victoria, TX 77904-1178
Phone
(361) 575-0611
Fax
(361) 582-2323
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2009

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

Authorized official

Name
Donald L Polzin
Title
Executive Direcotr
Phone
(361) 575-0611

Specialties & licenses 1

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

Addresses

Primary practice location

6502 Nursery Dr
Suite 100
Victoria, TX 77904-1178

Mailing address

6502 Nursery Dr.
Suite 100
Victoria, TX 77904-4112
Phone (361) 575-0611

Other identifiers 1

IdentifierTypeStateIssuer
001007430OtherTXCONTRACT NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Gulf Bend MHMR Center13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251417600000",
    "number": "1285668541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 NURSERY DR.",
            "address_2": "SUITE 100",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779044112",
            "telephone_number": "361-575-0611",
            "fax_number": "361-582-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 NURSERY DR",
            "address_2": "SUITE 100",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041178",
            "telephone_number": "361-575-0611",
            "fax_number": "361-582-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF BEND MRMR CENTER HCS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-08-28",
        "status": "A",
        "authorized_official_last_name": "POLZIN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECOTR",
        "authorized_official_telephone_number": "361-575-0611"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTRACT NUMBER",
            "identifier": "001007430",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; 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.