NPIMap

Organization Active NPI

Gulf Bend MRMR Center Icf/Mr

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Victoria, TX
National Provider Identifier
1649200684
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
GULF BEND MRMR CENTER ICF/MR
Practice address
306 Edinburgh St
Victoria, TX 77904-2864
Phone
(361) 575-0611
Fax
(361) 582-2329
NPI assigned
Jul 4, 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
Donald Polzin
Title
Executive Director
Phone
(361) 575-0611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

306 Edinburgh St
Victoria, TX 77904-2864

Mailing address

1502 E Airline Rd
Suite 25
Victoria, TX 77901-4112
Phone (361) 575-0611

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": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649200684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 E AIRLINE RD",
            "address_2": "SUITE 25",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779014112",
            "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": "306 EDINBURGH ST",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042864",
            "telephone_number": "361-575-0611",
            "fax_number": "361-582-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF BEND MRMR CENTER ICF/MR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLZIN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "361-575-0611"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 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.