Provider Demographics
NPI:1942492558
Name:AUSTIN REHAB OPERATIONS LLC
Entity Type:Organization
Organization Name:AUSTIN REHAB OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-335-4111
Mailing Address - Street 1:306 W 7TH ST STE 415
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4905
Mailing Address - Country:US
Mailing Address - Phone:817-335-4111
Mailing Address - Fax:817-335-0800
Practice Address - Street 1:110 E LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4355
Practice Address - Country:US
Practice Address - Phone:512-444-3511
Practice Address - Fax:512-444-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119262314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1015308Medicaid
675733Medicare Oscar/Certification