1639183973 NPI number — THERAPY CENTER INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639183973 NPI number — THERAPY CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY CENTER 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:
THERAPY CENTRAL
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:
1639183973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5309 N MCCOLL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504-2252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-664-1819
Provider Business Mailing Address Fax Number:
956-994-8299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5309 N MCCOLL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-2252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-664-1819
Provider Business Practice Location Address Fax Number:
956-994-8299
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CEDILLO
Authorized Official First Name:
ROSARIO
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-664-1819

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 172858601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002MV . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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