Contract Details
Ancillary Care Services
Facility name
Longview Therapy Center
Provider ID
P000003875
NPI
1134116536
Tax ID
391878099
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
110 Ruthlynn Drive
Longview, TX 75601
United States
County
Gregg
Phone
9037577731 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address