1811260193 NPI number — LITTLE LIGHTHOUSE CHILDRENS REHAB

Table of content: (NPI 1811260193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811260193 NPI number — LITTLE LIGHTHOUSE CHILDRENS REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE LIGHTHOUSE CHILDRENS REHAB
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:
1811260193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 W. OCEAN BLVD.
Provider Second Line Business Mailing Address:
STE. B
Provider Business Mailing Address City Name:
LOS FRESNOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78566-3620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-233-4119
Provider Business Mailing Address Fax Number:
956-233-4115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N REYNOLDS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-396-4029
Provider Business Practice Location Address Fax Number:
361-396-4034
Provider Enumeration Date:
02/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
RICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-792-3277

Provider Taxonomy Codes

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

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





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