Provider Demographics
NPI:1831672518
Name:BONAFIDE REHAB SERVICES, LLC
Entity Type:Organization
Organization Name:BONAFIDE REHAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ERUBEL
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:956-821-3646
Mailing Address - Street 1:1921 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-8323
Mailing Address - Country:US
Mailing Address - Phone:956-821-3646
Mailing Address - Fax:
Practice Address - Street 1:1921 S 34TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-8323
Practice Address - Country:US
Practice Address - Phone:956-821-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207861006Medicaid
TX207861007Medicaid