MEDICARE: CONCHO VALLEY CENTER FOR HUMAN ADVANCEMENT

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1184764185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCHO VALLEY CENTER FOR HUMAN ADVANCEMENT

Provider Business Mailing Address
First Line	:	1501 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-4004
Country	:	US
Telephone Number	:	325-658-7750
Fax Number	:	325-658-8381

Provider Business Practice Location Address
First Line	:	424 S OAKES ST
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-5944
Country	:	US
Telephone Number	:	325-658-7750
Fax Number	:

Authorized Official
Title or Position	:	IT DIRECTOR/CREDENTIALING SPECIALIS
Name	:	ALTON TODD BAIRD
Credential	:
Telephone Number	:	325-658-7750

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	05/04/2026

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515