1760402226 NPI number — CPRC HOLDINGS LLC

Table of content: (NPI 1760402226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760402226 NPI number — CPRC HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPRC HOLDINGS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHRONIC PAIN RECOVERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760402226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25134 OAKHURST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77386-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-271-0221
Provider Business Mailing Address Fax Number:
936-271-0219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25134 OAKHURST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77386-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-271-0221
Provider Business Practice Location Address Fax Number:
936-271-0219
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALIANELL
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
936-321-0214

Provider Taxonomy Codes

  • Taxonomy code: 103TR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 652320000 . This is a "ECPTOTE PT FACILITY LIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 206010500 . This is a "US DEPARTMENT OF LABOR ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0027PL . This is a "BCBSTX GROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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