Provider Demographics
NPI:1609003532
Name:GUEVARA ENTERPRISES INC.
Entity Type:Organization
Organization Name:GUEVARA ENTERPRISES INC.
Other - Org Name:OMEGA EVALUATION CENTER-OMEGA REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-526-2718
Mailing Address - Street 1:1819 TROUP HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5870
Mailing Address - Country:US
Mailing Address - Phone:903-526-2718
Mailing Address - Fax:903-526-2719
Practice Address - Street 1:1819 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5870
Practice Address - Country:US
Practice Address - Phone:903-526-2718
Practice Address - Fax:903-526-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-4703261Q00000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center