1184627531 NPI number — THE CHALON CORPORATION

Table of content: (NPI 1184627531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184627531 NPI number — THE CHALON CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHALON CORPORATION
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:
REHAB MANAGEMENT
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:
1184627531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKWALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75087-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-771-0999
Provider Business Mailing Address Fax Number:
972-771-2281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 W RALPH HALL PKWY
Provider Second Line Business Practice Location Address:
#120
Provider Business Practice Location Address City Name:
ROCKWALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75032-6664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-771-1090
Provider Business Practice Location Address Fax Number:
972-771-6543
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VAN AMBURGH
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
972-771-0999

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  612140000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 553130001 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 165348701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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