Provider Demographics
NPI:1043457583
Name:MEMORIAL HERMANN REHABILITATION HOSPITAL KATY, LLC
Entity type:Organization
Organization Name:MEMORIAL HERMANN REHABILITATION HOSPITAL KATY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, CAO & CHIEF LEGAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-242-2709
Mailing Address - Street 1:PO BOX 301536
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1536
Mailing Address - Country:US
Mailing Address - Phone:713-338-4127
Mailing Address - Fax:713-338-4158
Practice Address - Street 1:21720 KINGSLAND BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2551
Practice Address - Country:US
Practice Address - Phone:713-338-4127
Practice Address - Fax:713-338-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220238402Medicaid
TX220238402Medicaid