Provider Demographics
NPI:1427445808
Name:BETESDA ILG, LLC
Entity type:Organization
Organization Name:BETESDA ILG, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELVIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-461-6601
Mailing Address - Street 1:1205 HOOKS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3341
Mailing Address - Country:US
Mailing Address - Phone:956-461-6601
Mailing Address - Fax:956-461-6602
Practice Address - Street 1:1205 HOOKS AVE STE B
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3341
Practice Address - Country:US
Practice Address - Phone:956-461-6601
Practice Address - Fax:956-461-6602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETESDA ILG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-23
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation