Basic Information
Provider Information
NPI: 1861521791
EntityType: 2
ReplacementNPI:  
OrganizationName: WEST TEXAS REHABILITATION CENTER
LastName:  
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Credential:  
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Mailing Information
Address1: 4601 HARTFORD ST
Address2:  
City: ABILENE
State: TX
PostalCode: 796054603
CountryCode: US
TelephoneNumber: 3257933400
FaxNumber:  
Practice Location
Address1: 908 FIRST ST
Address2:  
City: OZONA
State: TX
PostalCode: 769430728
CountryCode: US
TelephoneNumber: 3253929872
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: CHILDS
AuthorizedOfficialFirstName: TIM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OF FINANCE
AuthorizedOfficialTelephone: 3257933400
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR0400X  Y Ambulatory Health Care FacilitiesClinic/CenterRehabilitation

No ID Information.


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