BRECKENRIDGE VILLAGE MALLARD HOUSE
NPI 1245427947
Intermediate Care Facility, Intellectual Disabilities in Tyler, TX
About Breckenridge Village Mallard House NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BRECKENRIDGE VILLAGE MALLARD HOUSE (NPI 1245427947) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Tyler, Texas and active in the NPI registry since September 2007. The organization holds a CLIA Waiver certificate valid through October 6, 2026 and lists Kevin King, Executive Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D2195152
Breckenridge Village Of Tyler · Tyler, TXOther Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
TYLER, TX 75704
TYLER, TX 75704
TYLER, TX 75704
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Breckenridge Village's NPI number?
The NPI number for Breckenridge Village is 1245427947. It was assigned to this organization in the NPPES registry on September 27, 2007. The provider is doing business as Breckenridge Village Mallard House.
Where is Breckenridge Village located?
Breckenridge Village is located at 15062 County Road 1145, Tyler, TX 75704. The listed phone number is (903) 956-8100.
What is Breckenridge Village's specialty?
The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.
Does Breckenridge Village hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D2195152) is associated with this NPI, valid through October 6, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Breckenridge Village was last updated on August 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
