Provider Demographics
NPI:1811260193
Name:LITTLE LIGHTHOUSE CHILDRENS REHAB
Entity type:Organization
Organization Name:LITTLE LIGHTHOUSE CHILDRENS REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-792-3277
Mailing Address - Street 1:503 W. OCEAN BLVD.
Mailing Address - Street 2:STE. B
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3620
Mailing Address - Country:US
Mailing Address - Phone:956-233-4119
Mailing Address - Fax:956-233-4115
Practice Address - Street 1:501 N REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4643
Practice Address - Country:US
Practice Address - Phone:361-396-4029
Practice Address - Fax:361-396-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation