Provider Demographics
NPI:1265649735
Name:LEGEND REHAB CENTER LLC
Entity Type:Organization
Organization Name:LEGEND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-776-3477
Mailing Address - Street 1:PO BOX 742685
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-2685
Mailing Address - Country:US
Mailing Address - Phone:713-776-3477
Mailing Address - Fax:713-776-3502
Practice Address - Street 1:10101 BISSONNET ST STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7855
Practice Address - Country:US
Practice Address - Phone:713-776-3477
Practice Address - Fax:713-776-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX543450000261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
00681UMedicare ID - Type UnspecifiedPROVIDER NUMBER