Provider Demographics
NPI:1588023071
Name:NEUROCARE REHAB DALLAS LLC
Entity Type:Organization
Organization Name:NEUROCARE REHAB DALLAS LLC
Other - Org Name:NEUROCARE OUTPATIENT REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-944-4865
Mailing Address - Street 1:2150 LAKESIDE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 LAKESIDE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4302
Practice Address - Country:US
Practice Address - Phone:213-944-4865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROCARE REHAB HOSPITALS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation