Basic Information
| Provider Information | |||||||||
| NPI: | 1720030927 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGH PLAINS BEHAVIORAL HEALTH, LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DESERT SPRINGS MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415000 | ||||||||
| Address2: | MSC 410691 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372415000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104919400 | ||||||||
| FaxNumber: | 2104913517 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 S FM 1788 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797062608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325631200 | ||||||||
| FaxNumber: | 4325638752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4325631200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 008326 | TX | X | Hospitals | Psychiatric Hospital | 323P00000X | 856605 | TX | X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
ID Information
| ID | Type | State | Issuer | Description | HH6631 | 01 | TX | BC RTC PROV # | OTHER | HH3809 | 01 | TX | BC IP SA PROV # | OTHER | 088528 | 05 | AZ | MEDICAID | HH0809 | 01 | TX | BC IP PSYCH PROV # | OTHER | NM600381 | 05 | NM | MEDICAID |