MEDICARE: RUTHE B. COWL REHABILITATION CENTER

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	59505	TX
2	251B00000X	Case Management Agency	39688	TX
3	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	104887	TX
4	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	116580	TX
5	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	101216	TX
6	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	615780000	TX
7	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	108458	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0032BG	OTHER	TX	BC/BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1598759573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTHE B. COWL REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	1220 N MALINCHE AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043-3354
Country	:	US
Telephone Number	:	956-722-2431
Fax Number	:	956-722-7553

Provider Business Practice Location Address
First Line	:	1220 N MALINCHE AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043-3354
Country	:	US
Telephone Number	:	956-722-2431
Fax Number	:	956-722-7553

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	ARIANA MORA
Credential	:
Telephone Number	:	956-722-2431

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	05/26/2021