Provider Demographics
NPI:1245315720
Name:LITTLE TEXANS CHILDREN'S REHABILITATION
Entity type:Organization
Organization Name:LITTLE TEXANS CHILDREN'S REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-347-2684
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:TX
Mailing Address - Zip Code:78594-0610
Mailing Address - Country:US
Mailing Address - Phone:956-347-2684
Mailing Address - Fax:956-347-2686
Practice Address - Street 1:411 E. MAIN
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:TX
Practice Address - Zip Code:78594
Practice Address - Country:US
Practice Address - Phone:956-347-2684
Practice Address - Fax:956-347-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1734568-01Medicaid
TX676595Medicare Oscar/Certification