Provider Demographics
NPI:1780729731
Name:RIVERKIDS HOUSTON THERAPY, LLC
Entity type:Organization
Organization Name:RIVERKIDS HOUSTON THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHANTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-306-0573
Mailing Address - Street 1:2522 WESTMINISTER ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4518
Mailing Address - Country:US
Mailing Address - Phone:281-997-8509
Mailing Address - Fax:
Practice Address - Street 1:2522 WESTMINISTER ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4518
Practice Address - Country:US
Practice Address - Phone:281-997-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health