Organization Name: | GULF BEND MRMR CENTER ICF/MR |
NPI Number: | 1932139979 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD L POLZIN (EXECUTIVE DIRECTOR) |
Mailing Address: | 102 Burnet St Port Lavaca |
State: | TX US |
Postal Code: | 779792611 |
Phone Number: | 3615750611 |
Fax Number: | 3615822329 |
NPI Enumeration Date: | 07/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |