Provider Demographics
NPI:1265700389
Name:GOLDEN PARADISE REHAB
Entity type:Organization
Organization Name:GOLDEN PARADISE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-461-2041
Mailing Address - Street 1:3005 E BUSINESS HIGHWAY 83 UNIT A
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3623
Mailing Address - Country:US
Mailing Address - Phone:956-461-2041
Mailing Address - Fax:956-461-2072
Practice Address - Street 1:3005 E BUSINESS HIGHWAY 83 UNIT A
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3623
Practice Address - Country:US
Practice Address - Phone:956-461-2041
Practice Address - Fax:956-461-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17798305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service