Contract Details
Ancillary Care Services
Facility name
Back To Action
Provider ID
P000004651
NPI
1487660734
Tax ID
364489029
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1801 North Ed Carey Drive Suite C
Harlingen, TX 78550
United States
County
Cameron
Phone
9564288951 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address