MEDICARE: LITTLE LIGHTHOUSE CHILDRENS REHAB

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942398151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE LIGHTHOUSE CHILDRENS REHAB

Provider Business Mailing Address
First Line	:	503 W OCEAN BLVD STE B
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-3620
Country	:	US
Telephone Number	:	956-233-4111
Fax Number	:	956-233-4115

Provider Business Practice Location Address
First Line	:	503 W OCEAN BLVD STE B
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-3620
Country	:	US
Telephone Number	:	956-233-4111
Fax Number	:	956-233-4115

Authorized Official
Title or Position	:	ASSITANT ADMINISTRATOR
Name	:	MR. RICK LEE PEREZ
Credential	:
Telephone Number	:	956-943-9600

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	04/25/2012

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