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General NPI Number Information
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NPI Number | 1821214537
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Entity Type | Organization
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Legal Business Name | SABINE VALLEY REGIONAL MHMR CENTER
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 107 WOODBINE PL UNIT 775
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City | LONGVIEW
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State | TX
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Zip | 75601-2912
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Country | US
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Telephone | 903-918-5806
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Fax | 903-295-5803
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Provider Business Mailing Address
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Address Line | 107 WOODBINE PL UNIT 775
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City | LONGVIEW
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State | TX
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Zip | 75601-2912
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Country | US
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Telephone | 903-918-5806
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Fax | 903-295-5803
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT/CREDENTIALING
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Name | ROSEMARY O VILLARREAL
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Credential |
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Telephone | 903-234-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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