MEDICARE: HARLINGEN INNOVATIVE REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center	24779	TX
2	261QR0400X	Rehabilitation Clinic/Center	24779	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0A6103	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386875144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARLINGEN INNOVATIVE REHAB LLC

Provider Business Mailing Address
First Line	:	1021 S F ST
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-6748
Country	:	US
Telephone Number	:	956-440-0806
Fax Number	:	956-440-0856

Provider Business Practice Location Address
First Line	:	1021 S F ST
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-6748
Country	:	US
Telephone Number	:	956-440-0806
Fax Number	:	956-440-0856

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST/OWNER
Name	:	MRS. ELEONZETTA BONILLA
Credential	:	M.S, CCC-SLP
Telephone Number	:	956-440-0806

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	11/02/2010

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Directions to “HARLINGEN INNOVATIVE REHAB LLC ” Practice Location

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