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	:	1891711164
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	:	104 PATRICIA LN
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-5138
Country	:	US
Telephone Number	:	936-521-6100
Fax Number	:

Authorized Official
Title or Position	:	REIMBURSEMENT MANAGER
Name	:	BEVERLY A STANDLEY
Credential	:
Telephone Number	:	936-521-6100

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/27/2015

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