Provider Demographics
NPI:1073595948
Name:WICHITA VALLEY REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:WICHITA VALLEY REHABILITATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-397-8200
Mailing Address - Street 1:302 LOOP 11
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-3705
Mailing Address - Country:US
Mailing Address - Phone:940-397-8200
Mailing Address - Fax:940-397-8240
Practice Address - Street 1:302 LOOP 11
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-3705
Practice Address - Country:US
Practice Address - Phone:940-397-8200
Practice Address - Fax:940-397-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007229283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HH1000OtherBCBS
453088Medicare ID - Type Unspecified