Provider Demographics
NPI:1285835017
Name:TANGRAM REHABILITAITON NETWORK, INC.
Entity Type:Organization
Organization Name:TANGRAM REHABILITAITON NETWORK, INC.
Other - Org Name:REHAB WITHOUT WALLS NEURO REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2100
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:800-866-0860
Mailing Address - Fax:
Practice Address - Street 1:2385 FM 1984
Practice Address - Street 2:
Practice Address - City:MAXWELL
Practice Address - State:TX
Practice Address - Zip Code:78656-4344
Practice Address - Country:US
Practice Address - Phone:800-866-0860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX763Medicaid