1235519430 NPI number — DEVELOPMENTAL REHAB SERVICES, INC

Table of content: (NPI 1235519430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235519430 NPI number — DEVELOPMENTAL REHAB SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL REHAB SERVICES, INC
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:
Provider Other Organization Name Type Code:
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:
1235519430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 111878
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-320-2670
Provider Business Mailing Address Fax Number:
713-583-7597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2656 S LOOP W STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054-2772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-786-4234
Provider Business Practice Location Address Fax Number:
713-583-7597
Provider Enumeration Date:
06/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
281-786-4234

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 113673 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3425787-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3425787-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402230302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4354938-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4329435-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4329435-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4354938-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402230301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4063794-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4063794-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4354936-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4467979-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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