1942239140 NPI number — HOUSTON NORTHWEST REHAB, LLC

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 1942239140 NPI number — HOUSTON NORTHWEST REHAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON NORTHWEST REHAB, 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:
1942239140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12205
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:
77391-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-353-8333
Provider Business Mailing Address Fax Number:
281-353-8367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4405 SPRING CYPRESS RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77388-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-353-8333
Provider Business Practice Location Address Fax Number:
281-353-8367
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
281-353-8333

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  10256 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 5392 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 9689 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 9683 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 1825A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 426564 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0086JB . This is a "BCBS OF TEXAS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8513BH . This is a "BCBS OF TX INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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