Provider Demographics
| NPI: | 1639232002 |
|---|---|
| Name: | SABINE VALLEY REGIONAL MHMR CENTER |
| Entity Type: | Organization |
| Organization Name: | SABINE VALLEY REGIONAL MHMR CENTER |
| Other - Org Name: | COMMUNITY HEALTHCORE |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CREDENTIALING SPECIALIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROSEMARY |
| Authorized Official - Middle Name: | O |
| Authorized Official - Last Name: | VILLARREAL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| 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: | 903-234-1639 |
| 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: | 903-234-1639 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-12-18 |
| Last Update Date: | 2022-06-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 00BM15 | Other | BLUE CROSS BLUE SHIELD |
| TX | 137921601 | Medicaid | |
| TX | 137921602 | Medicaid | |
| TX | 137921606 | Medicaid | |
| TX | 137921607 | Medicaid | |
| TX | 137921608 | Medicaid | |
| TX | 129201 | Other | SUPERIOR HEALTH PLAN CHIP |
| TX | CB6459 | Other | RAILROAD MEDICARE |
| TX | 137921606 | Medicaid |
