11817 LANDRUM INC (NPI# 1457822538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457822538 |
| Entity Type | Organization |
| Organization Name | 11817 LANDRUM INC |
| Practice Address |
3560 Delaware St Ste 207 Beaumont TX 77706-3059 |
| Mailing Address |
Po Box 310 Montgomery TX 77356-0310 |
| Practice Telephone | 4092998555 |
| Practice Fax Number | 8884954061 |
| Mailing Telephone | 2813525441 |
| Mailing Fax Number | 8884954061 |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |
| Authorized Official Name | RICK MATTHEWS (CEO) |
| Authorized Official Telephone | 2813525441 |
| Is Organization Subpart | Y |
| Parent Organization Name | 11817 LANDRUM INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Woodlands Recovery Centers Adolescent Program | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922519727 | 11817 Landrum Inc | Clinic/Center | 1505 Cornerstone Ct, Beaumont, TX 77706 | 2017-10-19 |
| Street Address |
3560 DELAWARE ST STE 207 |
| City | BEAUMONT |
| State | TX |
| Zip Code | 77706-3059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225572555 | Jason Mensah Do Pa | Psychiatry & Neurology | 3560 Delaware St Ste 207, Beaumont, TX 77706-3059 | 2016-12-06 |
| 1548889116 | Bridgett Fisk | Nurse Practitioner | 3560 Delaware St Ste 207, Beaumont, TX 77706-3059 | 2020-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982176293 | Allen Family Home Care LLC | In Home Supportive Care | 4055 Dowlen Rd Ste 112, Beaumont, TX 77706 | 2018-12-27 |
| 1730661174 | Joseph Pryor Ingram | Counselor | 5450 Folsom Road #3, Beaumont, TX 77706 | 2018-09-02 |
| 1336644582 | Jenny Lee Broaddus | Counselor | 8150 N. Major Dr., Beaumont, TX 77706 | 2018-03-29 |
| 1528584026 | Amanthia Peace Williams | Pedorthist | 3645 Calder Ave., Beaumont, TX 77706 | 2017-08-16 |
| 1356863286 | Nicole Denise Williams | Speech-Language Pathologist | 970 North 23rd Street, Beaumont, TX 77706 | 2017-07-12 |
| 1487038923 | Associates for Dental Health, Pllc | Dentist | 415 Dowlen Rd Ste A, Beaumont, TX 77706 | 2015-07-15 |
| 1508264532 | Rose Anne Essex | Dietitian, Registered | 3510 Charleston Ln, Beaumont, TX 77706 | 2014-12-08 |
| 1780001933 | C. Asteris, Inc. | Contractor | 1465 W. Lucas Dr., Beaumont, TX 77706 | 2014-03-26 |
| 1376985820 | Erica J Hayes M D P A | Preferred Provider Organization | 4a Bayou Brandt Drive, Beaumont, TX 77706 | 2013-07-25 |
| 1194162909 | Hezron Omanga | Pharmacist | 3585 N. Dowlen Road, Beaumont, TX 77706 | 2013-06-03 |
| Find all providers in zip 77706 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639428063 | Essex Brothers Management Co., L.L.C. | Clinic/Center | 5545 Eastex Freeway, Beaumont, TX 77706 | 2012-08-30 |
| 1073729810 | Recovery Council of Southeast Texas | Clinic/Center | 4675 Washington Blvd Ste C, Beaumont, TX 77707-4321 | 2007-05-16 |
| 1447575501 | Spindletop Mhmr Services | Clinic/Center | 2750 S 8th St, Building C, Beaumont, TX 77701-7719 | 2010-04-01 |
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| 1730713769 | Cen-tex Alcoholic Rehabilitation Center, Inc. | Clinic/Center | 2410 E Adams Ave, Temple, TX 76501-4600 | 2020-02-28 |
| 1154953917 | Finch Clinic, Pllc. | Clinic/Center | 1105 Memorial Dr Ste 102, Denison, TX 75020-2043 | 2020-02-10 |
| 1265063689 | Cenikorfoundation | Clinic/Center | 5501 Interstate Hwy 37, Corpus Christi, TX 78408 | 2020-02-04 |
| 1598306862 | Ethos Wellness-the Prairie Recovery Center | Clinic/Center | 5808 Wagner Rd, Round Top, TX 78954-5075 | 2019-10-08 |
| 1619539509 | Arc Counseling LLC | Clinic/Center | 5700 Nw Central Dr Ste 130, Houston, TX 77092-2000 | 2019-07-01 |
| 1982261988 | Davecolephd and Associates | Clinic/Center | 4702 Old Spanish Trl Ste 106, Houston, TX 77021-1718 | 2019-05-24 |
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| 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.