Provider Demographics
NPI:1417429945
Name:EVEREST REHABILITATION HOSPITAL TEMPLE, LLC
Entity Type:Organization
Organization Name:EVEREST REHABILITATION HOSPITAL TEMPLE, LLC
Other - Org Name:EVEREST REHABILITATION HOSPITAL TEMPLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-351-3321
Mailing Address - Street 1:5100 BELT LINE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7124
Mailing Address - Country:US
Mailing Address - Phone:469-713-1145
Mailing Address - Fax:
Practice Address - Street 1:23621 SE H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:469-713-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital