Provider Demographics
NPI:1851599864
Name:NISSI THERAPY CENTER OF EDINBURG, LLC
Entity Type:Organization
Organization Name:NISSI THERAPY CENTER OF EDINBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTCHEBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-681-7486
Mailing Address - Street 1:3511 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3370
Mailing Address - Country:US
Mailing Address - Phone:956-681-7486
Mailing Address - Fax:956-668-7486
Practice Address - Street 1:3511 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3370
Practice Address - Country:US
Practice Address - Phone:956-681-7486
Practice Address - Fax:956-668-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018383251E00000X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185834201Medicaid
TX185834201Medicaid