Provider Demographics
NPI:1447711528
Name:FUN HOUSE REHAB, LLC
Entity type:Organization
Organization Name:FUN HOUSE REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-638-0761
Mailing Address - Street 1:9620 STATE HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-8495
Mailing Address - Country:US
Mailing Address - Phone:956-638-0761
Mailing Address - Fax:956-329-2830
Practice Address - Street 1:11837 ACOSTA CIR W
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-7995
Practice Address - Country:US
Practice Address - Phone:956-638-0761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty