Provider Demographics
NPI:1144590027
Name:EAST TEXAS REHABILITATION, LLC
Entity Type:Organization
Organization Name:EAST TEXAS REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBER
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:903-757-4100
Mailing Address - Street 1:102 ROTHROCK DR STE D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-1537
Mailing Address - Country:US
Mailing Address - Phone:903-757-4100
Mailing Address - Fax:903-757-4125
Practice Address - Street 1:414 E LOOP 281
Practice Address - Street 2:SUITE 5
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7930
Practice Address - Country:US
Practice Address - Phone:903-960-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health