Provider Demographics
NPI:1871029264
Name:MEDCARE PEDIATRIC REHAB CENTER, LP
Entity Type:Organization
Organization Name:MEDCARE PEDIATRIC REHAB CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-995-9292
Mailing Address - Street 1:4818 E SAM HOUSTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3240
Mailing Address - Country:US
Mailing Address - Phone:713-773-5110
Mailing Address - Fax:832-323-5075
Practice Address - Street 1:4818 E SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3240
Practice Address - Country:US
Practice Address - Phone:713-773-5110
Practice Address - Fax:832-323-5075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCARE PEDIATRIC GROUP, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1801326-01Medicaid