Provider Demographics
NPI:1467923912
Name:PB TEXAS BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:PB TEXAS BEHAVIORAL CARE, LLC
Other - Org Name:PROMISES AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EDI/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-567-7256
Mailing Address - Street 1:PO BOX 207813
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7813
Mailing Address - Country:US
Mailing Address - Phone:830-798-2220
Mailing Address - Fax:
Practice Address - Street 1:840 COUNTY ROAD 420
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-3077
Practice Address - Country:US
Practice Address - Phone:830-798-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility