MEDICARE: EXALT HEALTH REHABILITATION HOSPITAL CONROE, 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	283X00000X	Rehabilitation Hospital

General Provider Information

NPI Number	:	1477304632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXALT HEALTH REHABILITATION HOSPITAL CONROE, LLC

Provider Business Mailing Address
First Line	:	2306 GUTHRIE RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2507 SOUTH LOOP 336 W
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304
Country	:	US
Telephone Number	:	972-414-6062
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHAD DEARDORFF
Credential	:
Telephone Number	:	214-213-8372

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	11/04/2024

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