Provider Demographics
NPI:1790859957
Name:NUECES COUNTY MHMR COMMUNITY CENTER
Entity Type:Organization
Organization Name:NUECES COUNTY MHMR COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-886-6900
Mailing Address - Street 1:PO BOX 71029
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78467-1029
Mailing Address - Country:US
Mailing Address - Phone:361-886-6900
Mailing Address - Fax:361-886-1379
Practice Address - Street 1:3733 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-4532
Practice Address - Country:US
Practice Address - Phone:361-886-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138305102Medicaid