Provider Demographics
NPI:1942239140
Name:HOUSTON NORTHWEST REHAB, LLC
Entity Type:Organization
Organization Name:HOUSTON NORTHWEST REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:281-353-8333
Mailing Address - Street 1:PO BOX 12205
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-2205
Mailing Address - Country:US
Mailing Address - Phone:281-353-8333
Mailing Address - Fax:281-353-8367
Practice Address - Street 1:4405 SPRING CYPRESS RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4400
Practice Address - Country:US
Practice Address - Phone:281-353-8333
Practice Address - Fax:281-353-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1825A101YA0400X
TX10256101YA0400X
TX5392101YA0400X
TX9689101YA0400X
TX9683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
426564OtherVALUE OPTIONS
TX0086JBOtherBCBS OF TEXAS GROUP
TX8513BHOtherBCBS OF TX INDIVIDUAL