Provider Demographics
NPI:1497997019
Name:A PLUS PEDIATRIC REHAB, INC.
Entity Type:Organization
Organization Name:A PLUS PEDIATRIC REHAB, INC.
Other - Org Name:A PLUS PEDIATRICS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-448-9111
Mailing Address - Street 1:9514 CONSOLE DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2042
Mailing Address - Country:US
Mailing Address - Phone:210-448-9111
Mailing Address - Fax:210-308-9595
Practice Address - Street 1:9514 CONSOLE DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2042
Practice Address - Country:US
Practice Address - Phone:210-448-9111
Practice Address - Fax:210-308-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
TX663890000261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3132839-01Medicaid
TX67-6690Medicare PIN