Provider Demographics
NPI:1093084717
Name:SABINE VALLEY REGIONAL MHMR CENTER DBA COMMUNITY HEALTHCORE
Entity Type:Organization
Organization Name:SABINE VALLEY REGIONAL MHMR CENTER DBA COMMUNITY HEALTHCORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:INMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-758-2471
Mailing Address - Street 1:PO BOX 6800
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-6800
Mailing Address - Country:US
Mailing Address - Phone:903-758-2471
Mailing Address - Fax:
Practice Address - Street 1:3320 TROUP HWY
Practice Address - Street 2:SUITE 285
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8395
Practice Address - Country:US
Practice Address - Phone:903-535-9274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health