Provider Demographics
NPI:1508933987
Name:ST. GILES BAYTOWN, INC.
Entity Type:Organization
Organization Name:ST. GILES BAYTOWN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-299-5161
Mailing Address - Street 1:4800 OVERTON PLZ STE 440
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4435
Mailing Address - Country:US
Mailing Address - Phone:800-299-5161
Mailing Address - Fax:817-447-3033
Practice Address - Street 1:3010 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7110
Practice Address - Country:US
Practice Address - Phone:936-639-1600
Practice Address - Fax:936-639-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001014227320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012310Medicaid
TX001012806Medicaid
TX001014229Medicaid
TX001012306Medicaid
TX001013797Medicaid
TX001012805Medicaid
TX001012309Medicaid
TX001012307Medicaid
TX001014227Medicaid
TX001013809Medicaid
TX001014230Medicaid