1841472115 NPI number — GREATER HEALTH AND REHABILITATION, LLC

Table of content: (NPI 1841472115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841472115 NPI number — GREATER HEALTH AND REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER HEALTH AND REHABILITATION, 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:
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:
1841472115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 GRANBURY ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CLEBURNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76033-4853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-641-9700
Provider Business Mailing Address Fax Number:
817-641-8190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 GRANBURY ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLEBURNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76033-4853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-641-9700
Provider Business Practice Location Address Fax Number:
817-641-8190
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TESSMAN
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
817-641-9700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9660 , registered in the state of TX ; 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: 13QQ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DN8302 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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