NPIMap

Organization Active NPI

Tamarack Residential Services

  • Mental Illness Intermediate Care Facility
  • Longview, TX
National Provider Identifier
1396700423
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
007599 Issued in TX
Legal business name
TAMARACK RESIDENTIAL SERVICES
Practice address
3730 E Loop Dr
Longview, TX 75602-6704
Phone
(903) 753-1979
Fax
(903) 753-7485
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Mike Hawker II
Title
Cfo
Phone
(210) 340-7155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 007599 TX Primary

Addresses

Primary practice location

3730 E Loop Dr
Longview, TX 75602-6704

Mailing address

845 Proton Rd
San Antonio, TX 78258-4203
Phone (210) 340-7155

Other names 1

  • Beverly Other name

National Provider Directory

National Provider Directory
Tax ID family
Beverly3 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.

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396700423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 PROTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584203",
            "telephone_number": "210-340-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 E LOOP DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756026704",
            "telephone_number": "903-753-1979",
            "fax_number": "903-753-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAMARACK RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAWKER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "210-340-7155",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "TX",
            "license": "007599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beverly",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.