Basic Information
| Provider Information | |||||||||
| NPI: | 1598759573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUTHE B. COWL REHABILITATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 N MALINCHE AVE | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780433354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567222431 | ||||||||
| FaxNumber: | 9567227553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 N MALINCHE AVE | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780433354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567222431 | ||||||||
| FaxNumber: | 9567227553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | MORA | ||||||||
| AuthorizedOfficialFirstName: | ARIANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 9567222431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 59505 | TX | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 251B00000X | 39688 | TX | N | Agencies | Case Management | 261QR0401X | 104887 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | 116580 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | 101216 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | 615780000 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | 108458 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
ID Information
| ID | Type | State | Issuer | Description | 094453001 | 05 | TX | MEDICAID | 094453003 | 05 | TX | MEDICAID | 1689969776 | 05 | TX | MEDICAID | 0032BG | 01 | TX | BC/BS | OTHER | 284880601 | 05 | TX | MEDICAID |