Healthcare Provider Details

I. General information

NPI: 1518021898
Provider Name (Legal Business Name): SPINDLETOP MHMR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S 8TH ST
BEAUMONT TX
77701-4624
US

IV. Provider business mailing address

655 S 8TH ST
BEAUMONT TX
77701-4624
US

V. Phone/Fax

Practice location:
  • Phone: 409-839-1000
  • Fax: 409-839-1066
Mailing address:
  • Phone: 409-839-1000
  • Fax: 409-839-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberNA
License Number StateTX

VIII. Authorized Official

Name: MR. NORMAN CHARLES HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 409-839-1000