1841536943 NPI number — ACCEL CUSTOM REHAB LLC

Table of content: (NPI 1841536943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841536943 NPI number — ACCEL CUSTOM REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCEL CUSTOM 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:
1841536943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6829 K AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75074-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-422-8280
Provider Business Mailing Address Fax Number:
972-422-8315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6829 K AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75074-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-422-8280
Provider Business Practice Location Address Fax Number:
972-422-8513
Provider Enumeration Date:
12/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
TED
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-422-8280

Provider Taxonomy Codes

  • Taxonomy code: 225CA2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 533974 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200530650A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5237564 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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