Healthcare Provider Details

I. General information

NPI: 1962557769
Provider Name (Legal Business Name): RGV REHAB NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 N. EXPRESSWAY 77, SUITE C
BROWNSVILLE TX
78526
US

IV. Provider business mailing address

1900 S. JACKSON RD, STE 2
MCALLEN TX
78503
US

V. Phone/Fax

Practice location:
  • Phone: 956-350-6696
  • Fax: 956-350-6604
Mailing address:
  • Phone: 956-630-4400
  • Fax: 956-630-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. JORGE A GONZALEZ
Title or Position: CFO/OWNER
Credential:
Phone: 956-630-4400