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General NPI Number Information
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NPI Number | 1588661060
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Entity Type | Organization
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Legal Business Name | PADRE BEHAVIORAL HEALTH SYSTEM, LLC
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6629 WOOLDRIDGE RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-2909
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Country | US
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Telephone | 361-986-9444
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Fax | 361-986-1897
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Provider Business Mailing Address
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Address Line | 6629 WOOLDRIDGE RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-2909
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Country | US
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Telephone | 361-986-9444
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Fax | 361-986-1897
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Authorized Official
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Title or Position | CEO-CFO
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Name | MR. JOHN SEWELL CROLEY
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Credential |
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Telephone | 361-986-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 007165
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License Number State | TX
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