Provider Demographics
NPI:1417044942
Name:COMPLETE REHABILITATION CLINIC,INC
Entity Type:Organization
Organization Name:COMPLETE REHABILITATION CLINIC,INC
Other - Org Name:COMPLETE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OFFIONG
Authorized Official - Middle Name:U
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-494-5141
Mailing Address - Street 1:3956 BLUEBONNET DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3952
Mailing Address - Country:US
Mailing Address - Phone:281-494-5141
Mailing Address - Fax:281-494-5143
Practice Address - Street 1:3956 BLUEBONNET DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3952
Practice Address - Country:US
Practice Address - Phone:281-494-5141
Practice Address - Fax:281-494-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0062064332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4497010001Medicare ID - Type Unspecified