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General NPI Number Information
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NPI Number | 1992906721
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Entity Type | Organization
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Legal Business Name | TANGRAM REHABILITATION NETWORK, INC.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 5309 TEXAS LONE STAR TRL
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City | MAXWELL
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State | TX
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Zip | 78656-3610
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Country | US
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Telephone | 512-396-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 WONDER WORLD DR STE 104
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City | SAN MARCOS
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State | TX
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Zip | 78666-7558
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Country | US
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Telephone | 512-396-1200
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Fax | 512-396-2024
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Authorized Official
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Title or Position | MGR PROVIDER ENROLLMENT
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Name | ANGIE MATTINGLY
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Credential |
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Telephone | 502-630-7425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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