Provider Demographics
NPI:1174196414
Name:WISHING WELL CENTERS FOR REHABILITATION, LLC
Entity Type:Organization
Organization Name:WISHING WELL CENTERS FOR REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:713-705-8313
Mailing Address - Street 1:2600 GESSNER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3844
Mailing Address - Country:US
Mailing Address - Phone:713-705-8313
Mailing Address - Fax:
Practice Address - Street 1:2600 GESSNER RD STE 190
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3844
Practice Address - Country:US
Practice Address - Phone:713-705-8313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation