Provider Demographics
NPI:1841399623
Name:LAGUNA MADRE REHABILITATION CENTER
Entity Type:Organization
Organization Name:LAGUNA MADRE REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PLATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-943-2248
Mailing Address - Street 1:225 MESQUITE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2450
Mailing Address - Country:US
Mailing Address - Phone:956-943-2248
Mailing Address - Fax:956-943-4459
Practice Address - Street 1:1200 STATE HIGHWAY 100
Practice Address - Street 2:STE 9
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2708
Practice Address - Country:US
Practice Address - Phone:956-943-2248
Practice Address - Fax:956-943-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178171801Medicaid
TX178171801Medicaid