Organization
HEALTH AND HUMAN SERVICES COMMISSION
Active
Other names
Brenham State Supported Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT SCHALCHLIN (ASSOCIATE COMMISSIONER)
(512) 438-3076
Entity
Organization
Contact information
Practice address
4001 HIGHWAY 36 S, BRENHAM, TX 77833-9610
(979) 836-4511
(979) 277-1865
Mailing address
4001 HIGHWAY 36 S, BRENHAM, TX 77833-9610
(979) 836-4511
(979) 277-1865
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
TX
2084N0400X
Neurology Physician
—
TX
2084P0800X
Psychiatry Physician
—
TX
208D00000X
General Practice Physician
—
TX
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
TX
363L00000X
Nurse Practitioner
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000711001
—
TX
01
—
0058ML
BCBSTX
TX
Enumeration date
11/03/2006
Last updated
02/05/2018
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