Provider Demographics
NPI:1114143641
Name:GREEN TREE REHABILITATION L.L.C.
Entity Type:Organization
Organization Name:GREEN TREE REHABILITATION L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:956-279-0704
Mailing Address - Street 1:PO BOX 5185
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5185
Mailing Address - Country:US
Mailing Address - Phone:956-279-0704
Mailing Address - Fax:
Practice Address - Street 1:3844 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3926
Practice Address - Country:US
Practice Address - Phone:956-279-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation