Provider Demographics
NPI:1750659603
Name:ANGELO BEHAVIOR CENTER, LLP
Entity Type:Organization
Organization Name:ANGELO BEHAVIOR CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-340-9899
Mailing Address - Street 1:12 E TWOHIG AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6433
Mailing Address - Country:US
Mailing Address - Phone:325-340-9899
Mailing Address - Fax:210-892-0080
Practice Address - Street 1:12 E TWOHIG AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6433
Practice Address - Country:US
Practice Address - Phone:325-340-9899
Practice Address - Fax:210-892-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty