1245315720 NPI number — LITTLE TEXANS CHILDREN'S REHABILITATION

Table of content: (NPI 1245315720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245315720 NPI number — LITTLE TEXANS CHILDREN'S REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE TEXANS CHILDREN'S REHABILITATION
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:
6
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:
1245315720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 610
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBASTIAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78594-0610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-347-2684
Provider Business Mailing Address Fax Number:
956-347-2686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 E. MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBASTIAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-347-2684
Provider Business Practice Location Address Fax Number:
956-347-2686
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOLIS
Authorized Official First Name:
IRMA
Authorized Official Middle Name:
LINDA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-347-2684

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1734568-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com