Provider Demographics
NPI:1760486708
Name:DORA ROBERTS REHABILITATION CENTER
Entity Type:Organization
Organization Name:DORA ROBERTS REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-267-3806
Mailing Address - Street 1:306 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2429
Mailing Address - Country:US
Mailing Address - Phone:432-267-3806
Mailing Address - Fax:432-267-3809
Practice Address - Street 1:306 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2429
Practice Address - Country:US
Practice Address - Phone:432-267-3806
Practice Address - Fax:432-267-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L09GOtherMEDICARE B
TX00L09GOtherMEDICARE B