Provider Demographics
NPI:1750799862
Name:ABILITY - ALL 4 KIDS, LLC
Entity type:Organization
Organization Name:ABILITY - ALL 4 KIDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-344-5437
Mailing Address - Street 1:10609 W IH 10
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1672
Mailing Address - Country:US
Mailing Address - Phone:210-344-5437
Mailing Address - Fax:210-340-1259
Practice Address - Street 1:7840 FM 1960 RD E
Practice Address - Street 2:STE 401
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2258
Practice Address - Country:US
Practice Address - Phone:281-548-2458
Practice Address - Fax:281-348-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297420601Medicaid