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General NPI Number Information
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NPI Number | 1578764296
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Entity Type | Organization
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Legal Business Name | MHMR SERVICES FOR THE CONCHO VALLEY
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 W BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76901-4004
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Country | US
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Telephone | 325-658-7750
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Fax | 325-658-8381
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Provider Business Mailing Address
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Address Line | 1501 W BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76901-4004
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Country | US
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Telephone | 325-658-7750
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Fax | 325-658-8381
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Authorized Official
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Title or Position | CFO
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Name | MR. TOM HOPKINS
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Credential |
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Telephone | 325-658-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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