Provider Demographics
NPI:1144590159
Name:PECAN VALLEY MHMR REGION
Entity Type:Organization
Organization Name:PECAN VALLEY MHMR REGION
Other - Org Name:PECAN VALLEY CENTERS FOR BEHAVIORAL AND DEVELOPMENTAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-579-4400
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-0729
Mailing Address - Country:US
Mailing Address - Phone:817-579-4400
Mailing Address - Fax:817-579-4407
Practice Address - Street 1:104 PIRATE DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5682
Practice Address - Country:US
Practice Address - Phone:817-573-5012
Practice Address - Fax:817-579-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3492-3494261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder