Provider Demographics
| NPI: | 1699741975 |
|---|---|
| Name: | ABILENE REGIONAL MHMR CENTER |
| Entity type: | Organization |
| Organization Name: | ABILENE REGIONAL MHMR CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO CHIEF EXECUTIVE OFFICER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | JENNIFER |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | GOODE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CEO |
| Authorized Official - Phone: | 325-690-5135 |
| Mailing Address - Street 1: | 2616 S CLACK |
| Mailing Address - Street 2: | STE 160 |
| Mailing Address - City: | ABILENE |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 79606-1557 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 325-690-5131 |
| Mailing Address - Fax: | 325-690-5263 |
| Practice Address - Street 1: | 2616 S CLACK |
| Practice Address - Street 2: | STE 160 |
| Practice Address - City: | ABILENE |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 79606-1557 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 325-690-5131 |
| Practice Address - Fax: | 325-690-5263 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-02-27 |
| Last Update Date: | 2024-06-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 133338702 | Medicaid | |
| TX | 00R652 | Other | MULTI-SPECIALITY |
| TX | 133338706 | Medicaid | |
| TX | 133338707 | Medicaid |
