MEDICARE: TRI-COUNTY BEHAVIORAL HEALTHCARE

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
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1841215175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 3067
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77305-3067
Country	:	US
Telephone Number	:	936-521-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	28902 ENCHANTED DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-1105
Country	:	US
Telephone Number	:	936-521-6100
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EVAN ROBERSON
Credential	:
Telephone Number	:	936-521-6100

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/27/2024

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