Pecan Ridge Living Center LTD

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

License

003799 Issued in TX

Legal business name

PECAN RIDGE LIVING CENTER LTD

Practice address

1916 Seley Ave
Waco, TX 76704-2057

Phone

(254) 799-6291

Fax

(254) 799-5340

NPI assigned

Nov 1, 2005

Organization subpart

Yes

Parent organization

SURREY HOLDINGS, INCAs reported in NPPES

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

Authorized official

Name

Mike Hawker

Title

Cfo

Phone

(210) 340-7155

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1891786638",
    "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",
            "fax_number": "210-340-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 SELEY AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767042057",
            "telephone_number": "254-799-6291",
            "fax_number": "254-799-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN RIDGE LIVING CENTER LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURREY HOLDINGS, INC",
        "enumeration_date": "2005-11-01",
        "last_updated": "2008-06-17",
        "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"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "TX",
            "license": "003799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001012117",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Payne
• Peace of Mind Homecare
• Brian Everett Peacock
• Pearl Counseling of Texas, PLLC
• John James Pearson, MA, BCBA
• Melissa Irene Pechal, FNP
• Pediatric Advanced Life Services Home Health LLC
• Carolina Pedriana
• Christin Leeann Peel, LMSW
• Andrea Pena, RN, IBCLC

• Mental Illness Intermediate Care Facility in Waco, TX
• Providers in Waco, TX by specialty
• Mental Illness Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.