Provider Demographics
NPI:1003100660
Name:NISAL CORP.
Entity Type:Organization
Organization Name:NISAL CORP.
Other - Org Name:QUALCARE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-378-0667
Mailing Address - Street 1:PO BOX 24809
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77229-4809
Mailing Address - Country:US
Mailing Address - Phone:713-378-0667
Mailing Address - Fax:713-300-9990
Practice Address - Street 1:10934 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1959
Practice Address - Country:US
Practice Address - Phone:713-450-2838
Practice Address - Fax:713-450-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9330111N00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty