NPIMap

Organization Active NPI

Breckenridge Village

Doing business as Breckenridge Village of Tyler

  • Intellectual Disabilities Intermediate Care Facility
  • Tyler, TX
National Provider Identifier
1477748010
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
BRECKENRIDGE VILLAGE
Doing business as
Breckenridge Village of Tyler
Practice address
15062 County Road 1145
Tyler, TX 75704-7516
Phone
(903) 956-8100
Fax
(903) 956-8104
NPI assigned
Sep 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Melissa Perkins
Title
President
Phone
(903) 596-8100

Specialties & licenses 1

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

Addresses

Primary practice location

15062 County Road 1145
Tyler, TX 75704-7516

Mailing address

15062 County Road 1145
Tyler, TX 75704-7516
Phone (903) 956-8100

Other names 1

  • Breckenridge Village of Tyler Doing business as

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1477748010",
    "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": "903-956-8104"
        },
        {
            "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": "903-956-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECKENRIDGE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "PERKINS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-596-8100"
    },
    "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 of Tyler",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Breckenridge Village of Tyler",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.