Provider Demographics
NPI:1285854190
Name:PECAN VALLEY MHMR REGION
Entity Type:Organization
Organization Name:PECAN VALLEY MHMR REGION
Other - Org Name:HCS PECAN VALLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:MIS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-397-3147
Mailing Address - Street 1:650 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3311
Mailing Address - Country:US
Mailing Address - Phone:254-965-7806
Mailing Address - Fax:
Practice Address - Street 1:650 W GREEN ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3311
Practice Address - Country:US
Practice Address - Phone:254-965-7806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities