Provider Demographics
NPI:1760501654
Name:LJP NORTHSTAR
Entity Type:Organization
Organization Name:LJP NORTHSTAR
Other - Org Name:LONE STAR REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-454-7571
Mailing Address - Street 1:100 S SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-4318
Mailing Address - Country:US
Mailing Address - Phone:956-487-7246
Mailing Address - Fax:
Practice Address - Street 1:100 S SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-4318
Practice Address - Country:US
Practice Address - Phone:956-487-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF004515261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center