Provider Demographics
NPI:1023105749
Name:RISING STARS THERAPY CENTER, LLC
Entity type:Organization
Organization Name:RISING STARS THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-4347
Mailing Address - Street 1:2402 BROCK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3257
Mailing Address - Country:US
Mailing Address - Phone:956-583-4347
Mailing Address - Fax:956-583-7793
Practice Address - Street 1:2402 BROCK ST
Practice Address - Street 2:SUITE B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3257
Practice Address - Country:US
Practice Address - Phone:956-583-4347
Practice Address - Fax:956-583-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-6598Medicare ID - Type UnspecifiedOPT REHABILITATION