BROOKHAVEN YOUTH RANCH, INC. (NPI# 1740321686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740321686 |
| Entity Type | Organization |
| Organization Name | BROOKHAVEN YOUTH RANCH, INC. |
| Practice Address |
5467 Rogers Hill Rd West TX 76691-2415 |
| Practice Telephone | 2548291893 |
| Practice Fax Number | 2548291469 |
| Mailing Telephone | 2548291893 |
| Mailing Fax Number | 2548291469 |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. BILL GHOLSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2548291893 |
| Authorized Official Credential | MSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 236482 | TX | Residential Treatment Facilities |
| Street Address |
5467 ROGERS HILL RD |
| City | WEST |
| State | TX |
| Zip Code | 76691-2415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841831534 | Terry Lynn Moore | Counselor | 5467 Rogers Hill Rd, West, TX 76691-2415 | 2019-10-03 |
| 1225595127 | Danielle J. Bryant | Marriage & Family Therapist | 5467 Rogers Hill Rd, West, TX 76691-2415 | 2019-02-27 |
| 1043528995 | Kira Nunn | Counselor | 5467 Rogers Hill Rd, West, TX 76691-2415 | 2010-09-14 |
| 1043352867 | Kathilyn Beard | Social Worker | 5467 Rogers Hill Rd, West, TX 76691-2415 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194243667 | Lauren Nicole Wernet | Specialist/Technologist | 305 Vardiman Rd, West, TX 76691 | 2017-09-05 |
| 1952433310 | P S Well-child Clinic | Family Medicine | 407 W Oak St., West, TX 76691 | 2007-03-12 |
| 1154467934 | Dr Walter J Mellgren Jr Dc Pa | Chiropractor | 109 N Regan St, West, TX 76691 | 2007-01-29 |
| 1093878092 | West Station Enterprise Inc | Durable Medical Equipment & Medical Supplies | 1579 Tokio Rd, West, TX 76691 | 2006-12-19 |
| 1790897601 | Generation Rx Inc. | Durable Medical Equipment & Medical Supplies | 206 N Main St, West, TX 76691 | 2006-08-31 |
| 1962416487 | Billy Don Pierce | General Practice | 407 W Oak St, West, TX 76691 | 2006-07-28 |
| 1891727004 | Avery Kirk Wines | Pharmacist | 200 N Main, West, TX 76691 | 2006-07-07 |
| 1083725816 | Paula Ann Snokhous | Physician Assistant | 407 W Oak St, West, TX 76691 | 2006-08-31 |
| 1558469312 | Larry D Sparks | Dentist | 312 N Main, West, TX 76691-0369 | 2006-09-20 |
| 1386675262 | Walter Jean Mellgren Jr. | Chiropractor | 109 N Reagan St, West, TX 76691-0475 | 2006-07-06 |
| Find all providers in zip 76691 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063030054 | Life's Purpose | Residential Treatment Facility, Emotionally Disturbed Children | 1211 Lark Ln, Richmond, TX 77469-7803 | 2020-07-07 |
| 1588293112 | Angelica Marie Griffin | Residential Treatment Facility, Emotionally Disturbed Children | 12500 Shadowglen Trace 3204, Manor, TX 78653 | 2020-04-06 |
| 1639702236 | The Landing At Corpus Christi | Residential Treatment Facility, Emotionally Disturbed Children | 2058 Fm 665, Corpus Christi, TX 78415 | 2020-02-21 |
| 1083158943 | Pinnacle Hc LLC | Residential Treatment Facility, Emotionally Disturbed Children | 980 S Coit Rd, 1322, Prosper, TX 75078-2989 | 2016-12-12 |
| 1932558517 | The Eunice House, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 1114 Watson Crossing Way, Houston, TX 77067-1627 | 2016-06-06 |
| 1033577119 | 2nd Chanze Organization | Residential Treatment Facility, Emotionally Disturbed Children | 27102 Breton Bridge Ct, Cypress, TX 77433-7552 | 2016-02-04 |
| 1780073452 | Oyin'da LLC | Residential Treatment Facility, Emotionally Disturbed Children | 5551 Latta Plantation Dr, Katy, TX 77449-1557 | 2015-01-17 |
| 1376883322 | Angels With Open Arms | Residential Treatment Facility, Emotionally Disturbed Children | 6435 Tumbling Creek Trl, Dallas, TX 75241-5915 | 2013-02-27 |
| 1316201981 | Treathem, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2904 1st St, Bay City, TX 77414-6828 | 2012-06-28 |
| 1588939532 | Turning Point Children's Social Services | Residential Treatment Facility, Emotionally Disturbed Children | 2224 Spring Creek Dr, Spring, TX 77373-6138 | 2012-03-08 |
| Find all providers with the same taxonomy | ||||
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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.