1104899509 NPI number — OPTIMUM KIDS LTD

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 1104899509 NPI number — OPTIMUM KIDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUM KIDS LTD
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:
ALTON REHAB FOR KIDS
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:
1104899509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 720754
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-664-9955
Provider Business Mailing Address Fax Number:
956-664-9957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 E US BUSINESS 83
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-664-9955
Provider Business Practice Location Address Fax Number:
956-664-9957
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPEIGHTS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-664-9955

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  654180000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0401X , with the licence number: 551950000 , 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: 454839 . This is a "FACILITY MEDICARE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".
  • Identifier: 1631301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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