Provider Demographics
NPI:1023336773
Name:LAREDO AUTISTIC AND KIDS REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:LAREDO AUTISTIC AND KIDS REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-712-9111
Mailing Address - Street 1:2110 LOMAS DEL SUR UNIT 114115
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5750
Mailing Address - Country:US
Mailing Address - Phone:956-712-9111
Mailing Address - Fax:956-712-8421
Practice Address - Street 1:2110 LOMAS DEL SUR UNIT 114115
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5750
Practice Address - Country:US
Practice Address - Phone:956-712-9111
Practice Address - Fax:956-712-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation