Provider Demographics
NPI:1194065946
Name:SAN JUAN LIFE SKILLS REHAB @ HOME, LLC
Entity type:Organization
Organization Name:SAN JUAN LIFE SKILLS REHAB @ HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-283-7556
Mailing Address - Street 1:1110 S STEWART RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-5167
Mailing Address - Country:US
Mailing Address - Phone:956-283-7556
Mailing Address - Fax:956-283-7557
Practice Address - Street 1:1110 S STEWART RD STE C
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-5167
Practice Address - Country:US
Practice Address - Phone:956-283-7556
Practice Address - Fax:956-283-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health