Provider Demographics
NPI:1912089962
Name:ANGELINA REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:ANGELINA REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOHINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:936-632-2107
Mailing Address - Street 1:402 S JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3107
Mailing Address - Country:US
Mailing Address - Phone:936-632-2107
Mailing Address - Fax:936-632-2108
Practice Address - Street 1:402 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3107
Practice Address - Country:US
Practice Address - Phone:936-632-2107
Practice Address - Fax:936-632-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082055261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454887OtherMEDICARE PART A ID - CORF
TX454887Medicare Oscar/Certification
TX6089640001Medicare NSC