Provider Demographics
NPI:1558407122
Name:PERMIAN BASIN COMMUNITY CENTERS FOR MHMR
Entity Type:Organization
Organization Name:PERMIAN BASIN COMMUNITY CENTERS FOR MHMR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:432-570-3333
Mailing Address - Street 1:401 E ILLINOIS
Mailing Address - Street 2:STE 400
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-570-3333
Mailing Address - Fax:432-570-3346
Practice Address - Street 1:400 N CARVER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-570-3385
Practice Address - Fax:432-570-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health