Provider Demographics
NPI:1275899759
Name:SMILE N GROW REHAB LLC
Entity Type:Organization
Organization Name:SMILE N GROW REHAB LLC
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:956-461-3411
Mailing Address - Street 1:605 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2725
Mailing Address - Country:US
Mailing Address - Phone:956-461-3411
Mailing Address - Fax:956-461-3416
Practice Address - Street 1:605 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2725
Practice Address - Country:US
Practice Address - Phone:956-461-3411
Practice Address - Fax:956-461-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195485106Medicaid
TX207596202Medicaid