Padre Behavioral Health System, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

007165 Issued in TX

Legal business name

PADRE BEHAVIORAL HEALTH SYSTEM, LLC

Practice address

6629 Wooldridge Rd
Corpus Christi, TX 78414-2909

Phone

(361) 986-9444

Fax

(361) 986-1897

NPI assigned

Jun 30, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Sewell Croley

Title

Ceo-Cfo

Phone

(361) 986-9444

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588661060. Details of each certification follow.

• CCN 454096 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 454096

Legal name

PADRE BEHAVIORAL HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Dec 11, 2011

Provider type (POS)

Hospital – Psychiatric

Participating since

Jul 26, 2000

Last certification

Jul 26, 2000

Beds

68 (36 certified)

Ownership / control type

Private (for profit)

Facility address

6629 Wooldridge Rd
Corpus Christi, TX 78414

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588661060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6629 WOOLDRIDGE RD",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784142909",
            "telephone_number": "361-986-9444",
            "fax_number": "361-986-1897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6629 WOOLDRIDGE RD",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784142909",
            "telephone_number": "361-986-9444",
            "fax_number": "361-986-1897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PADRE BEHAVIORAL HEALTH SYSTEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CROLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SEWELL",
        "authorized_official_title_or_position": "CEO-CFO",
        "authorized_official_telephone_number": "361-986-9444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "TX",
            "license": "007165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PARTIAL",
            "identifier": "HH6788",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PSYCH",
            "identifier": "HH0978",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CD",
            "identifier": "HH3978",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maricela Selene Pacheco, M.D.
• Bryan Michael Pachuta, RN
• Jason Packard, DDS
• Kevin Earl Packard, D.D.S.
• Viviana Padilla
• Padre Dermatology PLLC
• Padre Home and Clinic Healthcare, PLLC
• Padre Home Health, Inc.
• Padre Island Counseling, PLLC
• Padre Island ER Physicians PLLC

• Psychiatric Hospital in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Psychiatric Hospital in Texas

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.