Healthcare Provider Details

I. General information

NPI: 1912089962
Provider Name (Legal Business Name): ANGELINA REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S JOHN REDDITT DR
LUFKIN TX
75904-3107
US

IV. Provider business mailing address

402 S JOHN REDDITT DR
LUFKIN TX
75904-3107
US

V. Phone/Fax

Practice location:
  • Phone: 936-632-2107
  • Fax: 936-632-2108
Mailing address:
  • Phone: 936-632-2107
  • Fax: 936-632-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number1082055
License Number StateTX

VIII. Authorized Official

Name: DR. VINOD R SOHINI
Title or Position: OWNER
Credential: DPT
Phone: 936-632-2107