MEDICARE: GO GO CARE REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1083071625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO GO CARE REHAB LLC

Provider Business Mailing Address
First Line	:	912 E NOLANA LOOP
Second Line	:	SUITE G
City	:	PHARR
State	:	TX
Zip	:	78577-5838
Country	:	US
Telephone Number	:	956-502-5717
Fax Number	:	956-720-0882

Provider Business Practice Location Address
First Line	:	912 E NOLANA LOOP
Second Line	:	SUITE G
City	:	PHARR
State	:	TX
Zip	:	78577-5838
Country	:	US
Telephone Number	:	956-502-5717
Fax Number	:	956-720-0882

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MR. BALDEMAR GARCIA
Credential	:
Telephone Number	:	956-502-5717

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	01/27/2016

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