Provider Demographics
NPI:1578703906
Name:ADVANCED HEALTH & REHAB CENTER
Entity Type:Organization
Organization Name:ADVANCED HEALTH & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-540-2225
Mailing Address - Street 1:1420 FM 1960 BYPASS RD E
Mailing Address - Street 2:STE 122
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3934
Mailing Address - Country:US
Mailing Address - Phone:281-540-2225
Mailing Address - Fax:281-540-2621
Practice Address - Street 1:1420 FM 1960 BYPASS RD E
Practice Address - Street 2:STE 122
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3934
Practice Address - Country:US
Practice Address - Phone:281-540-2225
Practice Address - Fax:281-540-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10260302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization