Provider Demographics
NPI:1639386865
Name:LUBBOCK REGIONAL MHMR CENTER
Entity Type:Organization
Organization Name:LUBBOCK REGIONAL MHMR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-766-0310
Mailing Address - Street 1:1602 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2607
Mailing Address - Country:US
Mailing Address - Phone:806-766-0310
Mailing Address - Fax:806-744-9580
Practice Address - Street 1:3105 29TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-3022
Practice Address - Country:US
Practice Address - Phone:806-766-0310
Practice Address - Fax:806-744-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369701OtherICFMR CONTRACT NUMBER