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NPI Code Detail

MEDICARE: HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER

MEDICARE: HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center2007020591TX
2251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801986542
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER
Provider Business Mailing Address
First Line : PO BOX 890
Second Line :
City : WACO
State : TX
Zip : 76703-0890
Country : US
Telephone Number : 254-752-3451
Fax Number : 254-756-3133
Provider Business Practice Location Address
First Line : 110 S 12TH ST
Second Line :
City : WACO
State : TX
Zip : 76701-1810
Country : US
Telephone Number : 254-752-3451
Fax Number : 254-756-3133
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DANIEL THOMPSON
Credential :
Telephone Number : 254-752-3451
Provider Enumeration Date : 10/13/2006
Last Update Date : 04/07/2022

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Practice Location Address:
110 S 12TH ST
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Practice Phone: 254-752-3451
Practice Fax: 254-756-3133

Directions to “HEART OF TEXAS REGION MENTAL HEALTH MENTAL RETARDATION CENTER ” Practice Location

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