Provider Demographics
NPI:1255635629
Name:ALTON KIDS REHAB, LLC
Entity type:Organization
Organization Name:ALTON KIDS REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:956-357-9196
Mailing Address - Street 1:3013 E MAIN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0931
Mailing Address - Country:US
Mailing Address - Phone:956-581-7200
Mailing Address - Fax:956-581-7201
Practice Address - Street 1:3013 E MAIN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-0931
Practice Address - Country:US
Practice Address - Phone:956-581-7200
Practice Address - Fax:956-581-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation