Provider Demographics
NPI:1578764296
Name:MHMR SERVICES FOR THE CONCHO VALLEY
Entity Type:Organization
Organization Name:MHMR SERVICES FOR THE CONCHO VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-658-7750
Mailing Address - Street 1:1501 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4004
Mailing Address - Country:US
Mailing Address - Phone:325-658-7750
Mailing Address - Fax:325-658-8381
Practice Address - Street 1:1501 W BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-4004
Practice Address - Country:US
Practice Address - Phone:325-658-7750
Practice Address - Fax:325-658-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services