Provider Demographics
NPI:1710368428
Name:COVENANT REHABILITATION HOSPITAL OF LUBBOCK LLC
Entity Type:Organization
Organization Name:COVENANT REHABILITATION HOSPITAL OF LUBBOCK LLC
Other - Org Name:TRUSTPOINT REHABILITATION HOSPITAL OF LUBBOCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-2299
Mailing Address - Street 1:1024 N GALLOWAY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2434
Mailing Address - Country:US
Mailing Address - Phone:972-216-2299
Mailing Address - Fax:
Practice Address - Street 1:4302 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1304
Practice Address - Country:US
Practice Address - Phone:806-740-8400
Practice Address - Fax:806-749-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67T050Medicare Oscar/Certification