Provider Demographics
NPI:1982872883
Name:SELOUS HEALTHCARE LLC
Entity Type:Organization
Organization Name:SELOUS HEALTHCARE LLC
Other - Org Name:BEYOND BOUNDARIES PEDIATRIC THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-878-4094
Mailing Address - Street 1:517 COTTONWOOD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-524-7773
Practice Address - Street 1:704 LONGMIRE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1850
Practice Address - Country:US
Practice Address - Phone:936-441-2500
Practice Address - Fax:936-539-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)