Provider Demographics
NPI:1033744743
Name:MEDICAL BEHAVIORAL HOSPITAL OF CLEAR LAKE, LLC
Entity Type:Organization
Organization Name:MEDICAL BEHAVIORAL HOSPITAL OF CLEAR LAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-277-2630
Mailing Address - Street 1:112 W JEFFERSON BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1921
Mailing Address - Country:US
Mailing Address - Phone:574-277-2530
Mailing Address - Fax:574-277-2635
Practice Address - Street 1:16850 BUCCANEER LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2507
Practice Address - Country:US
Practice Address - Phone:574-277-2630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital