Provider Demographics
NPI:1760402226
Name:CPRC HOLDINGS LLC
Entity Type:Organization
Organization Name:CPRC HOLDINGS LLC
Other - Org Name:CHRONIC PAIN RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIANELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-321-0214
Mailing Address - Street 1:25134 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1421
Mailing Address - Country:US
Mailing Address - Phone:936-271-0221
Mailing Address - Fax:936-271-0219
Practice Address - Street 1:25134 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1421
Practice Address - Country:US
Practice Address - Phone:936-271-0221
Practice Address - Fax:936-271-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX652320000OtherECPTOTE PT FACILITY LIC
TX206010500OtherUS DEPARTMENT OF LABOR ID
TX0027PLOtherBCBSTX GROUP PIN