Provider Demographics
NPI:1235162264
Name:KIDS PLAYHOUSE REHAB LP
Entity Type:Organization
Organization Name:KIDS PLAYHOUSE REHAB LP
Other - Org Name:KIDS PLAYHOUSE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-6200
Mailing Address - Street 1:3601 BUDDY OWENS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6447
Mailing Address - Country:US
Mailing Address - Phone:956-631-6200
Mailing Address - Fax:956-631-6433
Practice Address - Street 1:3601 BUDDY OWENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6447
Practice Address - Country:US
Practice Address - Phone:956-631-6200
Practice Address - Fax:956-631-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06921133NN1002X
225100000X, 225X00000X, 235Z00000X
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163485902OtherNUTRITION
TX153143604OtherNUTRITION
TX180599601Medicaid
TX180599602OtherCSHCN
TX163485902OtherNUTRITION
TX45-4875Medicare PIN