NPIMap

Organization Active NPI

Pecan Valley MHMR Region

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Weatherford, TX
National Provider Identifier
1710105812
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
361001 Issued in TX
Legal business name
PECAN VALLEY MHMR REGION
Practice address
1212 S Mill St
Weatherford, TX 76086-5734
Phone
(817) 598-0559
NPI assigned
Apr 23, 2007
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
Ralph Whaite
Title
Mis Director
Phone
(940) 397-3147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 361001 TX Primary

Addresses

Primary practice location

1212 S Mill St
Weatherford, TX 76086-5734

Mailing address

650 W Green St
Stephenville, TX 76401-3311
Phone (254) 965-7806

Other identifiers 1

IdentifierTypeStateIssuer
361001OtherTXDADS CONTRACT

Other names 1

  • Mill St. Other name

National Provider Directory

National Provider Directory
Tax ID family
Pecan Valley MHMR Region23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710105812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W GREEN ST",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764013311",
            "telephone_number": "254-965-7806",
            "fax_number": "254-965-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 S MILL ST",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760865734",
            "telephone_number": "817-598-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN VALLEY MHMR REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHAITE",
        "authorized_official_first_name": "RALPH",
        "authorized_official_title_or_position": "MIS DIRECTOR",
        "authorized_official_telephone_number": "940-397-3147"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TX",
            "license": "361001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DADS CONTRACT",
            "identifier": "361001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mill St.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Weatherford, 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.