Contract Details
Ancillary Care Services
Facility name
Pit Stop Rehab
Provider ID
P000005602
NPI
1912175118
Tax ID
202983340
Effective Date
4/30/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
119 North College Avenue
Cleveland, TX 77327
United States
County
Liberty
Phone
2815923008 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address