Provider Demographics
NPI:1104124346
Name:CHILDRENS REHABILITATION CLINIC
Entity type:Organization
Organization Name:CHILDRENS REHABILITATION CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-351-5422
Mailing Address - Street 1:2616 W FREDDY GONZALEZ DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7351
Mailing Address - Country:US
Mailing Address - Phone:956-289-8441
Mailing Address - Fax:956-289-8419
Practice Address - Street 1:1620 E 8TH ST
Practice Address - Street 2:STE. 3
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5883
Practice Address - Country:US
Practice Address - Phone:956-351-5422
Practice Address - Fax:956-351-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-12
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation