Provider Demographics
NPI:1336442854
Name:SAN CRISTOBAL TREATMENT CENTER
Entity Type:Organization
Organization Name:SAN CRISTOBAL TREATMENT CENTER
Other - Org Name:TRS BEHAVIORAL CARE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-627-4389
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:877-627-4389
Mailing Address - Fax:
Practice Address - Street 1:176 CAMINO DEL MEDIO
Practice Address - Street 2:
Practice Address - City:SAN CRISTOBAL
Practice Address - State:NM
Practice Address - Zip Code:87564
Practice Address - Country:US
Practice Address - Phone:575-776-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRS BEHAVIORAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065335401Medicaid