Provider Demographics
NPI:1598759573
Name:RUTHE B. COWL REHABILITATION CENTER
Entity Type:Organization
Organization Name:RUTHE B. COWL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-722-2431
Mailing Address - Street 1:1220 N MALINCHE AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3354
Mailing Address - Country:US
Mailing Address - Phone:956-722-2431
Mailing Address - Fax:956-722-7553
Practice Address - Street 1:1220 N MALINCHE AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3354
Practice Address - Country:US
Practice Address - Phone:956-722-2431
Practice Address - Fax:956-722-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59505104100000X
TX39688251B00000X
TX108458261QR0401X
TX104887261QR0401X
TX116580261QR0401X
TX101216261QR0401X
TX615780000261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094453001Medicaid
TX094453003Medicaid
TX1689969776Medicaid
TX0032BGOtherBC/BS
TX284880601Medicaid
TX094453001Medicaid
TX0032BGOtherBC/BS