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General NPI Number Information
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NPI Number | 1104958701
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Entity Type | Organization
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Legal Business Name | PERMIAN BASIN REHABILITATION CENTER FOR CRIPPLED CHILDREN AND ADULTS
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 620 N ALLEGHANEY AVE
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City | ODESSA
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State | TX
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Zip | 79761-4408
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Country | US
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Telephone | 432-332-8244
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Fax | 432-580-7428
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Provider Business Mailing Address
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Address Line | 620 N ALLEGHANEY AVE
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City | ODESSA
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State | TX
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Zip | 79761-4408
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Country | US
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Telephone | 432-332-8244
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Fax | 432-580-7428
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMBERLY RUBY ORTEGA
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Credential |
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Telephone | 432-332-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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