Provider Demographics
NPI:1982948972
Name:D.C. REHAB CENTER, LLC
Entity type:Organization
Organization Name:D.C. REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-980-8119
Mailing Address - Street 1:4646 CORONA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4320
Mailing Address - Country:US
Mailing Address - Phone:361-980-8119
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4320
Practice Address - Country:US
Practice Address - Phone:361-980-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation