Provider Demographics
NPI:1386875144
Name:HARLINGEN INNOVATIVE REHAB LLC
Entity type:Organization
Organization Name:HARLINGEN INNOVATIVE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEONZETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:956-440-0806
Mailing Address - Street 1:1021 S F ST
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6748
Mailing Address - Country:US
Mailing Address - Phone:956-440-0806
Mailing Address - Fax:956-440-0856
Practice Address - Street 1:1021 S F ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6748
Practice Address - Country:US
Practice Address - Phone:956-440-0806
Practice Address - Fax:956-440-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24779261QH0700X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6103OtherMEDICARE PTAN
TX202804501Medicaid