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General NPI Number Information
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NPI Number | 1639386865
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Entity Type | Organization
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Legal Business Name | LUBBOCK REGIONAL MHMR CENTER
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 3105 29TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-3022
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Country | US
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Telephone | 806-766-0310
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Fax | 806-744-9580
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Provider Business Mailing Address
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Address Line | 1602 10TH ST
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City | LUBBOCK
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State | TX
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Zip | 79401-2607
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Country | US
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Telephone | 806-766-0310
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Fax | 806-744-9580
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Authorized Official
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Title or Position | CEO
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Name | CATHY POPE
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Credential |
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Telephone | 806-766-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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