Provider Demographics
NPI:1457366254
Name:REHAB RANCH OF EL PASO, LLC
Entity Type:Organization
Organization Name:REHAB RANCH OF EL PASO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-581-1198
Mailing Address - Street 1:6666 MORRILL RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2608
Mailing Address - Country:US
Mailing Address - Phone:915-877-5602
Mailing Address - Fax:915-877-7308
Practice Address - Street 1:6666 MORRILL RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-2608
Practice Address - Country:US
Practice Address - Phone:915-877-5602
Practice Address - Fax:915-877-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095MXOtherBLUE CROSS/BLUE SHIELD