Provider Demographics
NPI:1639246143
Name:BUCKNER CHILDREN & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:BUCKNER CHILDREN & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPPORT - AP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-866-0976
Mailing Address - Street 1:9055 MANION DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3856
Mailing Address - Country:US
Mailing Address - Phone:409-866-0976
Mailing Address - Fax:409-866-8190
Practice Address - Street 1:9055 MANION DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3856
Practice Address - Country:US
Practice Address - Phone:409-866-0976
Practice Address - Fax:409-866-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1339329251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114634202Medicaid
TX040757901Medicaid
TX079958701Medicaid
TX1528336609Medicaid
TX028726001Medicaid
TX038912401Medicaid
TX133330403Medicaid
TX027863201Medicaid