Provider Demographics
NPI:1083733364
Name:PECAN VALLEY MHMR REGION
Entity Type:Organization
Organization Name:PECAN VALLEY MHMR REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-579-4400
Mailing Address - Street 1:2101 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1894
Mailing Address - Country:US
Mailing Address - Phone:817-579-4400
Mailing Address - Fax:866-452-5424
Practice Address - Street 1:2101 W PEARL ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1894
Practice Address - Country:US
Practice Address - Phone:817-579-4400
Practice Address - Fax:866-452-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130724101Medicaid