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Contract Details
Ancillary Care Services
Facility name
Back To Action
Provider ID
P000006607
Tax ID
383724407
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
1000 Crowne Ridge Boulevard Suite C
Eagle Pass, TX 78852
United States
County
Maverick
Phone
8307572497
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
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Address