Provider Demographics
NPI:1205970530
Name:TRS BEHAVIORAL CARE
Entity type:Organization
Organization Name:TRS BEHAVIORAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACT MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVASI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:505-550-9182
Mailing Address - Street 1:902 W ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4604
Mailing Address - Country:US
Mailing Address - Phone:713-528-3709
Mailing Address - Fax:713-528-7915
Practice Address - Street 1:3401 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-3806
Practice Address - Country:US
Practice Address - Phone:713-526-0311
Practice Address - Fax:713-526-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562-K261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder