Provider Demographics
NPI:1215361720
Name:RANCHO EL CHARCO THERAPY CENTER
Entity Type:Organization
Organization Name:RANCHO EL CHARCO THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-521-9258
Mailing Address - Street 1:100 N KIKA DE LA GARZA
Mailing Address - Street 2:
Mailing Address - City:LA JOY
Mailing Address - State:TX
Mailing Address - Zip Code:78560
Mailing Address - Country:US
Mailing Address - Phone:956-581-0395
Mailing Address - Fax:956-584-9488
Practice Address - Street 1:100 N KIKA DE LA GARZA
Practice Address - Street 2:
Practice Address - City:LA JOY
Practice Address - State:TX
Practice Address - Zip Code:78560
Practice Address - Country:US
Practice Address - Phone:956-581-0395
Practice Address - Fax:956-584-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TX104096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2168189-05Medicaid
TX101612OtherTEXAS STATE BOARD LICENSE