NPIMap

Organization Active NPI

Heart of Texas Region Mental Health Mental Retardation Center

  • Adolescent and Children Mental Health Clinic/Center
  • Waco, TX
National Provider Identifier
1952485195
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
2007020591 Issued in TX
Legal business name
HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER
Practice address
1105 Jefferson Ave
Waco, TX 76701-1212
Phone
(254) 752-7889
Fax
(254) 752-7899
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

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

Authorized official

Name
Mr. Daniel Thompson
Title
Executive Director
Phone
(254) 752-3451

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2007020591 TX Primary

Addresses

Primary practice location

1105 Jefferson Ave
Waco, TX 76701-1212

Mailing address

110 S 12TH St
P O Box 890
Waco, TX 76701-1810
Phone (254) 752-3451

Other identifiers 1

IdentifierTypeStateIssuer
111409202MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Heart of Texas Region Mental Health Mental Retardation Center16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1952485195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S 12TH ST",
            "address_2": "P O BOX 890",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767011810",
            "telephone_number": "254-752-3451",
            "fax_number": "254-752-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 JEFFERSON AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767011212",
            "telephone_number": "254-752-7889",
            "fax_number": "254-752-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "254-752-3451",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "TX",
            "license": "2007020591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111409202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.