Healthcare Provider Details

I. General information

NPI: 1508933987
Provider Name (Legal Business Name): ST. GILES - BAYTOWN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 S 1ST ST
LUFKIN TX
75901-7110
US

IV. Provider business mailing address

4800 OVERTON PLZ STE 440
FORT WORTH TX
76109-4435
US

V. Phone/Fax

Practice location:
  • Phone: 936-639-1600
  • Fax: 936-639-1632
Mailing address:
  • Phone: 800-299-5161
  • Fax: 817-447-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number001014227
License Number StateTX

VIII. Authorized Official

Name: BRANDI TURNER
Title or Position: LICENSING COORDINATOR
Credential:
Phone: 682-707-2756