=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336334168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABILENE REGIONAL MHMR CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2007
-----------------------------------------------------
Last Update Date | 09/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 765 ORANGE ST
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79601-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-690-5131
-----------------------------------------------------
Fax | 325-690-5228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2616 S CLACK ST
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79606-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-690-5131
-----------------------------------------------------
Fax | 325-690-5228
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SPECIALIST
-----------------------------------------------------
Name | JANE PALIVEC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-690-5131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------