Provider Demographics
NPI:1992836936
Name:SPINDLETOP MHMR SERVICES
Entity Type:Organization
Organization Name:SPINDLETOP MHMR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-839-1000
Mailing Address - Street 1:2750 S 8TH ST
Mailing Address - Street 2:P O BOX 3846
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-7719
Mailing Address - Country:US
Mailing Address - Phone:409-839-1000
Mailing Address - Fax:409-839-1066
Practice Address - Street 1:2750 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-7719
Practice Address - Country:US
Practice Address - Phone:409-839-1000
Practice Address - Fax:409-839-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001007211320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007211Medicaid