Provider Demographics
NPI:1821397985
Name:CHILDRENS REHABILITATION CLINIC
Entity Type:Organization
Organization Name:CHILDRENS REHABILITATION CLINIC
Other - Org Name:CHILDREN'S REHABILITATION CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-627-2862
Mailing Address - Street 1:4418 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9608
Mailing Address - Country:US
Mailing Address - Phone:956-627-2862
Mailing Address - Fax:956-627-3823
Practice Address - Street 1:4418 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9608
Practice Address - Country:US
Practice Address - Phone:956-627-2862
Practice Address - Fax:956-627-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation