Provider Demographics
NPI:1275834251
Name:HILL COUNTRY COUNCIL ON ALCOHOL AND DRUG ABUSE, INC.
Entity Type:Organization
Organization Name:HILL COUNTRY COUNCIL ON ALCOHOL AND DRUG ABUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-367-4667
Mailing Address - Street 1:102 BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4326
Mailing Address - Country:US
Mailing Address - Phone:830-367-4667
Mailing Address - Fax:830-367-4687
Practice Address - Street 1:102 BUSINESS DR W
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4326
Practice Address - Country:US
Practice Address - Phone:830-367-4667
Practice Address - Fax:830-367-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2196-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285791798Medicaid