Provider Demographics
NPI:1164416988
Name:NACOGDOCHES REHABILITATION GROUP, INC
Entity Type:Organization
Organization Name:NACOGDOCHES REHABILITATION GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:936-552-7044
Mailing Address - Street 1:3205 N UNIVERSITY DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2683
Mailing Address - Country:US
Mailing Address - Phone:936-552-7044
Mailing Address - Fax:936-552-7050
Practice Address - Street 1:3205 N UNIVERSITY DR
Practice Address - Street 2:SUITE M
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2683
Practice Address - Country:US
Practice Address - Phone:936-552-7044
Practice Address - Fax:936-552-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101582261QP2000X
TX1108322261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049HVOtherBCBSTX PROVIDOR #
TX5856810001OtherMEDICARE SUPPLIER / DME#
TXP00016007/DA2661OtherMEDICARE RAILROAD ID/GROU
TX5856810001OtherDME
TX5856810001OtherCIGNA
TX170788701Medicaid
TX00909TMedicare PIN