Healthcare Provider Details

I. General information

NPI: 1811260193
Provider Name (Legal Business Name): LITTLE LIGHTHOUSE CHILDRENS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N REYNOLDS ST
ALICE TX
78332-4643
US

IV. Provider business mailing address

503 W. OCEAN BLVD. STE. B
LOS FRESNOS TX
78566-3620
US

V. Phone/Fax

Practice location:
  • Phone: 361-396-4029
  • Fax: 361-396-4034
Mailing address:
  • Phone: 956-233-4119
  • Fax: 956-233-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK L PEREZ
Title or Position: OWNER
Credential:
Phone: 956-792-3277