Healthcare Provider Details

I. General information

NPI: 1548542830
Provider Name (Legal Business Name): CPRH I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 ESPLANADE DR
CORPUS CHRISTI TX
78414-4165
US

IV. Provider business mailing address

5726 ESPLANADE DR
CORPUS CHRISTI TX
78414-4165
US

V. Phone/Fax

Practice location:
  • Phone: 361-906-3700
  • Fax: 361-985-0519
Mailing address:
  • Phone: 361-906-3700
  • Fax: 361-985-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHARLIE COOKE
Title or Position: CEO/CFO
Credential:
Phone: 361-906-3700