BRECKENRIDGE VILLAGE (NPI# 1245427947) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245427947 |
| Entity Type | Organization |
| Organization Name | BRECKENRIDGE VILLAGE |
| Other Organization Name | BRECKENRIDGE VILLAGE MALLARD HOUSE |
| Practice Address |
15062 County Road 1145 Tyler TX 75704-7516 |
| Practice Telephone | 9039568100 |
| Practice Fax Number | 9035968104 |
| Mailing Telephone | 9039568100 |
| Mailing Fax Number | 9035968104 |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2019-08-26 |
| Authorized Official Name | KEVIN KING (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9038968100 |
| Is Organization Subpart | Y |
| Parent Organization Name | BAPTIST CHILD & FAMILY SERVICES INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Breckenridge Village Mallard House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477748010 | Breckenridge Village | Intermediate Care Facility, Mentally Retarded | 15062 County Road 1145, Tyler, TX 75704-7516 | 2007-09-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Vermont Business Registrations | BRECKENRIDGE VILLAGE | 100 Hospital Dr, Bennington, VT 05201 |
| Street Address |
15062 COUNTY ROAD 1145 |
| City | TYLER |
| State | TX |
| Zip Code | 75704-7516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023138062 | Educare Community Living Limited Partnership | Intermediate Care Facility, Mentally Retarded | 15062 County Road 1145, Tyler, TX 75704-7516 | 2007-03-31 |
| 1770969768 | Baptist Care Facilities for Person's With Mental Disabilties | Assisted Living Facility | 15062 County Road 1145, Tyler, TX 75704-7516 | 2015-08-03 |
| 1477748010 | Breckenridge Village | Intermediate Care Facility, Mentally Retarded | 15062 County Road 1145, Tyler, TX 75704-7516 | 2007-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194325415 | Rupal R Patel | Pharmacist | 3820 Tx 64, Tyler, TX 75704 | 2020-10-27 |
| 1932757945 | Gracelyn Hernandez Kuester | Technician | 14320 Country Road 420, Tyler, TX 75704 | 2019-09-03 |
| 1033770227 | Rajamanoj Kondaveeti | Dentist | 3873 Tx-64, Tyler, TX 75704 | 2019-06-27 |
| 1063070209 | Susan Michele Whitaker | Counselor | The Beginning, 114 Jordan Plaza Blvd Suite 302, Tyler, TX 75704 | 2019-06-03 |
| 1649836768 | Tyla Sherrie' Tarrant | Licensed Vocational Nurse | 3050 Cr 427, #502, Tyler, TX 75704 | 2019-05-14 |
| 1437458874 | North Mesa Dental, PC | Dentist | 3864 Hwy 64 West, Tyler, TX 75704 | 2011-03-24 |
| 1093025751 | Zana Elliot Enterprises LLC | Nurse Practitioner | 12751 Westbrook Dr, Tyler, TX 75704 | 2010-10-15 |
| 1710036454 | Tammy Jimenez | Dietitian, Registered | 5555 W. Twin Lakes Dr., Tyler, TX 75704 | 2007-01-10 |
| 1063023935 | Shanika Lanell Grant | Licensed Vocational Nurse | 134 Patton Ln, Tyler, TX 75704-2004 | 2020-08-13 |
| 1194342410 | Shanequia Dianne Flowers | Licensed Vocational Nurse | 404 Lemay Dr, Tyler, TX 75704-2031 | 2020-07-02 |
| Find all providers in zip 75704 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225639271 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 3323 Gail Ln, Tyler, TX 75701-7425 | 2020-11-05 |
| 1124629175 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 2616 Pounds Ave, Tyler, TX 75701-5627 | 2020-11-05 |
| 1568063527 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 2525 Preston Ave, Tyler, TX 75701-4644 | 2020-11-05 |
| 1104427509 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 2812 Shaffer Ln, Tyler, TX 75702-1653 | 2020-11-03 |
| 1487255873 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 3600 New Copeland Rd, Tyler, TX 75701-8839 | 2020-11-03 |
| 1023138062 | Educare Community Living Limited Partnership | Intermediate Care Facility, Mentally Retarded | 15062 County Road 1145, Tyler, TX 75704-7516 | 2007-03-31 |
| 1477748010 | Breckenridge Village | Intermediate Care Facility, Mentally Retarded | 15062 County Road 1145, Tyler, TX 75704-7516 | 2007-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902900 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 2500 Terry Pl, Greenville, TX 75402-7131 | 2020-11-05 |
| 1811598865 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 100 Patti J St, Greenville, TX 75402-8053 | 2020-11-05 |
| 1265033658 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 3506 Garber Cir, Greenville, TX 75402-6234 | 2020-11-03 |
| 1306446000 | Daybreak, Inc. | Intermediate Care Facility, Mentally Retarded | 6520 Braddock Pl, Dallas, TX 75232-2902 | 2020-10-30 |
| 1578179750 | Keondra C Johnson | Intermediate Care Facility, Mentally Retarded | 2140 Medical District Dr Apt 2052, Dallas, TX 75235-8097 | 2020-09-22 |
| 1467062869 | Affluent Health Care Services Inc. | Intermediate Care Facility, Mentally Retarded | 7542 Autumn Sun Dr, Houston, TX 77083-6915 | 2020-07-31 |
| 1053951772 | Daybreak, Inc. | Intermediate Care Facility, Mentally Retarded | 1809 Auburn Dr, Richardson, TX 75081-3123 | 2020-01-10 |
| 1124668850 | Daybreak, Inc. | Intermediate Care Facility, Mentally Retarded | 2100 Cedar Cir, Carrollton, TX 75006-1922 | 2020-01-10 |
| 1295375913 | Daybreak, Inc. | Intermediate Care Facility, Mentally Retarded | 974 E Cedar St, Seguin, TX 78155-3844 | 2020-01-10 |
| 1033759758 | Daybreak, Inc. | Intermediate Care Facility, Mentally Retarded | 4801 Bermuda Dr, San Angelo, TX 76904-7204 | 2020-01-10 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BRECKENRIDGE VILLAGE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.