MAINSTREAM HABILITATION SERVICES OF TEXAS, INC. (NPI# 1679531503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679531503 |
| Entity Type | Organization |
| Organization Name | MAINSTREAM HABILITATION SERVICES OF TEXAS, INC. |
| Practice Address |
717 Mountain Ridge Ct W Lakeside TX 76135-4925 |
| Mailing Address |
Po Box 1677 1728 Pease Street Vernon TX 76385-1677 |
| Practice Telephone | 8172378329 |
| Practice Fax Number | 8172389606 |
| Mailing Telephone | 9405522979 |
| Mailing Fax Number | 9405522987 |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. LISA ANN SMITH (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 9405522979 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 116728 | TX | Nursing & Custodial Care Facilities |
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 116726 | TX | Nursing & Custodial Care Facilities |
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 112011 | TX | Nursing & Custodial Care Facilities |
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 116454 | TX | Nursing & Custodial Care Facilities |
| Street Address |
717 MOUNTAIN RIDGE CT W |
| City | LAKESIDE |
| State | TX |
| Zip Code | 76135-4925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992283501 | Sung Ryel Choi | Dentist | 6014 Azle Ave # 100, Lake Worth, TX 76135 | 2018-08-06 |
| 1750882056 | Kandess Klein | Licensed Vocational Nurse | 8825 Claiborn St, Lakeside, TX 76135 | 2018-02-22 |
| 1841791258 | Robyn Rich | Technician | 5104 Prestwick Drive, Fort Worth, TX 76135 | 2018-02-22 |
| 1598207821 | Young Men's Christian Association of Metropolitan Fort Worth | Health Educator | 5315 Boat Club Rd, Fort Worth, TX 76135 | 2016-11-17 |
| 1558818534 | Clearfork Academy Lp | Substance Abuse Rehabilitation Facility | 7820 Hanger Cut Off, Fort Worth, TX 76135 | 2016-09-07 |
| 1316300999 | National Vision, Inc. | Technician/Technologist | 6014 Azle Ave, Ste 200, Lake Worth, TX 76135 | 2016-04-01 |
| 1457647570 | Cynthia Rosaline Witt | Optometrist | 6014 Azle Avenue, Suite 300, Lake Worth, TX 76135 | 2011-06-27 |
| 1316134125 | Home Town Dental,pa | Dentist | 6332 Lake Worth, Lake Worth, TN 76135 | 2007-09-26 |
| 1790984789 | Jonathan Nicholas Valamides | Optometrist | 6060 Azle Ave. Suite 500, Lake Worth, TX 76135 | 2007-07-11 |
| 1457570053 | Dawn Denise Ezelle | Occupational Therapy Assistant | 3400 Marine Drive, Fort Worth, TX 76135 | 2007-04-24 |
| Find all providers in zip 76135 | ||||
| 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 |
|---|---|---|---|---|
| 1730361569 | The Arc of San Diego | Intermediate Care Facility, Mentally Retarded | 9075 Creekford Drive, Lakeside, CA 92040 | 2007-12-04 |
| 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 |
| 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 |
| 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 |
| 1265033658 | St. Giles Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 3506 Garber Cir, Greenville, TX 75402-6234 | 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 |
| 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 |
| 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.