Provider Demographics
NPI:1780752105
Name:SUPERKIDS REHABILITATION INC.
Entity type:Organization
Organization Name:SUPERKIDS REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-831-7600
Mailing Address - Street 1:4430 E 14TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3363
Mailing Address - Country:US
Mailing Address - Phone:956-831-7600
Mailing Address - Fax:956-831-0386
Practice Address - Street 1:4430 E 14TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3363
Practice Address - Country:US
Practice Address - Phone:956-831-7600
Practice Address - Fax:956-831-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552160000261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1677775-01Medicaid
TX1677775-01Medicaid
TX00791WMedicare ID - Type UnspecifiedPART B