Provider Demographics
NPI: | 1932441383 |
---|---|
Name: | HEALTHCARE REHAB GROUP, INC. |
Entity Type: | Organization |
Organization Name: | HEALTHCARE REHAB GROUP, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STAR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCOTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 214-339-2047 |
Mailing Address - Street 1: | PO BOX 224585 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75222-4585 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 214-339-2047 |
Mailing Address - Fax: | 214-339-2049 |
Practice Address - Street 1: | 5201 S WESTMORELAND RD |
Practice Address - Street 2: | |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75237-1622 |
Practice Address - Country: | US |
Practice Address - Phone: | 214-339-2047 |
Practice Address - Fax: | 214-339-2049 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-25 |
Last Update Date: | 2022-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 10714 | 101Y00000X, 101YM0800X |
TX | 23078 | 103TB0200X, 103TC0700X, 103TP2701X, 103TR0400X |
TX | 9202 | 111N00000X, 111NR0400X, 111NX0100X |
TX | P2873 | 207Q00000X, 208100000X, 2081P2900X, 208D00000X, 208VP0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 111NR0400X | Chiropractic Providers | Chiropractor | Rehabilitation | Group - Multi-Specialty |
No | 111NX0100X | Chiropractic Providers | Chiropractor | Occupational Health | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | UR58292 | Medicare UPIN |