Provider Demographics
NPI:1780781716
Name:RAPHA NURSING & REHABILITATION CLINIC, INC
Entity type:Organization
Organization Name:RAPHA NURSING & REHABILITATION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:FUNSHO
Authorized Official - Last Name:FADIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-776-2500
Mailing Address - Street 1:11000 FONDREN RD
Mailing Address - Street 2:C-5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5513
Mailing Address - Country:US
Mailing Address - Phone:713-776-2500
Mailing Address - Fax:
Practice Address - Street 1:11000 FONDREN RD
Practice Address - Street 2:C-5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5513
Practice Address - Country:US
Practice Address - Phone:713-776-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008552251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX066118304Medicaid