Provider Demographics
NPI:1770969768
Name:BAPTIST CARE FACILITIES FOR PERSON'S WITH MENTAL DISABILTIES
Entity type:Organization
Organization Name:BAPTIST CARE FACILITIES FOR PERSON'S WITH MENTAL DISABILTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCCA
Authorized Official - Phone:903-596-8100
Mailing Address - Street 1:15062 COUNTY ROAD 1145
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-7516
Mailing Address - Country:US
Mailing Address - Phone:903-596-8100
Mailing Address - Fax:903-596-8104
Practice Address - Street 1:15062 COUNTY ROAD 1145
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-7516
Practice Address - Country:US
Practice Address - Phone:903-596-8100
Practice Address - Fax:903-596-8104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BCFS HHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137372310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility