Provider Demographics
NPI:1942398151
Name:LITTLE LIGHTHOUSE CHILDRENS REHAB
Entity Type:Organization
Organization Name:LITTLE LIGHTHOUSE CHILDRENS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSITANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-943-9600
Mailing Address - Street 1:503 W OCEAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3620
Mailing Address - Country:US
Mailing Address - Phone:956-233-4111
Mailing Address - Fax:956-233-4115
Practice Address - Street 1:503 W OCEAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3620
Practice Address - Country:US
Practice Address - Phone:956-233-4111
Practice Address - Fax:956-233-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174327001Medicaid
TX174327001Medicaid