Provider Demographics
NPI:1538317045
Name:BCA OF TEXAS LLC
Entity Type:Organization
Organization Name:BCA OF TEXAS LLC
Other - Org Name:BCA PERMIAN BASIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNELISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-939-4026
Mailing Address - Street 1:3300 S FM 1788
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-2601
Mailing Address - Country:US
Mailing Address - Phone:254-939-4026
Mailing Address - Fax:254-939-2334
Practice Address - Street 1:3300 S FM 1788
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2601
Practice Address - Country:US
Practice Address - Phone:254-939-4026
Practice Address - Fax:254-939-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital