Provider Demographics
NPI:1912049156
Name:MANAGED CARE CENTER, INC.
Entity type:Organization
Organization Name:MANAGED CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:806-780-8300
Mailing Address - Street 1:2345 50TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2565
Mailing Address - Country:US
Mailing Address - Phone:806-780-8300
Mailing Address - Fax:806-780-8383
Practice Address - Street 1:2345 50TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2565
Practice Address - Country:US
Practice Address - Phone:806-780-8300
Practice Address - Fax:806-780-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX846101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065363601Medicaid
TXHH6646OtherBCBS