Provider Demographics
NPI:1760661946
Name:BAXMART LLC
Entity Type:Organization
Organization Name:BAXMART LLC
Other - Org Name:INTERVENTION AND RECOVERY PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-485-8356
Mailing Address - Street 1:2245 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4144
Mailing Address - Country:US
Mailing Address - Phone:281-485-8356
Mailing Address - Fax:
Practice Address - Street 1:2245 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4144
Practice Address - Country:US
Practice Address - Phone:281-485-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2519-A3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children