Provider Demographics
NPI:1942522545
Name:FUN KIDS REHAB LLC
Entity Type:Organization
Organization Name:FUN KIDS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:NOE
Authorized Official - Last Name:OLIVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-893-3144
Mailing Address - Street 1:25224 N KANSAS CITY
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559
Mailing Address - Country:US
Mailing Address - Phone:956-893-3144
Mailing Address - Fax:
Practice Address - Street 1:115 W COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-5108
Practice Address - Country:US
Practice Address - Phone:956-893-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation