Provider Demographics
NPI:1871584672
Name:ACOVILL MANAGEMENT CO., L.L.C.
Entity type:Organization
Organization Name:ACOVILL MANAGEMENT CO., L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-424-3733
Mailing Address - Street 1:2101 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3228
Mailing Address - Country:US
Mailing Address - Phone:956-424-3733
Mailing Address - Fax:956-424-3734
Practice Address - Street 1:2101 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3228
Practice Address - Country:US
Practice Address - Phone:956-424-3733
Practice Address - Fax:956-424-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167185101Medicaid
TX676579Medicare PIN