Provider Demographics
NPI:1740475706
Name:LITTLE LIGHTHOUSE CHILDREN'S REHAB., LLC
Entity type:Organization
Organization Name:LITTLE LIGHTHOUSE CHILDREN'S REHAB., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:956-792-3277
Mailing Address - Street 1:503 W OCEAN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3635
Mailing Address - Country:US
Mailing Address - Phone:956-797-2100
Mailing Address - Fax:956-797-0000
Practice Address - Street 1:503 W OCEAN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3635
Practice Address - Country:US
Practice Address - Phone:956-797-2100
Practice Address - Fax:956-797-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation