Provider Demographics
NPI:1083870778
Name:MARY LEE FOUNDATION
Entity Type:Organization
Organization Name:MARY LEE FOUNDATION
Other - Org Name:MARY LEE FOUNDATION REHABILITATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-443-5777
Mailing Address - Street 1:1328 LAMAR SQUARE DR.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-443-1360
Mailing Address - Fax:512-443-1758
Practice Address - Street 1:1339 LAMAR SQUARE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-443-1360
Practice Address - Fax:512-443-1758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY LEE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-01
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation