Healthcare Provider Details

I. General information

NPI: 1316132483
Provider Name (Legal Business Name): LITTLE LIGHTHOUSE CHILDREN'S REHAB., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH MAIN STREET
LA FERIA TX
78559-8810
US

IV. Provider business mailing address

139 VALENCIA
BAYVIEW TX
78566-4605
US

V. Phone/Fax

Practice location:
  • Phone: 956-233-4111
  • Fax: 956-233-4115
Mailing address:
  • Phone: 956-792-3277
  • Fax: 956-943-9605

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. RICARDO PEREZ
Title or Position: OWNER
Credential: SLP
Phone: 956-792-3277