Provider Demographics
NPI:1760593412
Name:OCCUCARE, LTD.
Entity Type:Organization
Organization Name:OCCUCARE, LTD.
Other - Org Name:OCCUCARE REHABILITATION & WELLNESS CTR.
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-639-1014
Mailing Address - Street 1:PO BOX 151238
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-1238
Mailing Address - Country:US
Mailing Address - Phone:936-639-1014
Mailing Address - Fax:936-639-1099
Practice Address - Street 1:2305 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5429
Practice Address - Country:US
Practice Address - Phone:936-633-7700
Practice Address - Fax:936-633-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00699UMedicare ID - Type UnspecifiedMEDICARE PROVIDER #