Healthcare Provider Details

I. General information

NPI: 1033784178
Provider Name (Legal Business Name): NUECES COUNTY MHMR COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S BROWNLEE BLVD
CORPUS CHRISTI TX
78404-3134
US

IV. Provider business mailing address

1630 S BROWNLEE BLVD
CORPUS CHRISTI TX
78404-3134
US

V. Phone/Fax

Practice location:
  • Phone: 361-886-6900
  • Fax:
Mailing address:
  • Phone: 361-886-6900
  • Fax: 361-886-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SUSIE MARTINEZ
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 361-886-1037