Provider Demographics
NPI:1467676544
Name:SABINE VALLEY REGIONAL MHMR CENTER
Entity Type:Organization
Organization Name:SABINE VALLEY REGIONAL MHMR CENTER
Other - Org Name:SABINE VALLEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:O
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:PESC
Authorized Official - Phone:903-234-4226
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:903-234-0862
Practice Address - Street 1:107 WOODBINE PL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-2912
Practice Address - Country:US
Practice Address - Phone:903-758-2471
Practice Address - Fax:903-234-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007205OtherCONTRACT NUMBER