Provider Demographics
NPI:1558460535
Name:SPRINGS REHABILITATION FOUNDER HOLDINGS, PC
Entity type:Organization
Organization Name:SPRINGS REHABILITATION FOUNDER HOLDINGS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDFORD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SCHOCKET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-584-8404
Mailing Address - Street 1:7951 SHOAL CREEK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7582
Mailing Address - Country:US
Mailing Address - Phone:512-584-8404
Mailing Address - Fax:719-634-4042
Practice Address - Street 1:6025 DELMONICO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2251
Practice Address - Country:US
Practice Address - Phone:719-634-7246
Practice Address - Fax:855-592-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33700174400000X
CO0033700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021366Medicaid
COF99754Medicare UPIN
COG44617Medicare UPIN
F99754Medicare UPIN
COC469958Medicare ID - Type Unspecified
COC331608Medicare PIN
C331608Medicare PIN
CO04021366Medicaid