# RENAISSANCE OUTPATIENT REHABILITATION CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164688925
- **Authorized official:** MRS. IMEDA CASTILLO MS,CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
- **Authorized official phone:** (956) 586-2600

## Contact information

- **Practice address:** 2010 E GRIFFIN PKWY, MISSION, TX 78572-3223
- **Practice address phone:** (956) 583-2600
- **Practice address fax:** (956) 583-8580
- **Mailing address:** 2010 E GRIFFIN PKWY, MISSION, TX 78572-3223
- **Mailing address phone:** (956) 583-2600
- **Mailing address fax:** (956) 583-8580

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 103816 | TX | Yes |

## Other

- **Enumeration date:** 07/31/2008
- **Last updated:** 07/31/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 103816 | STATE LICENSE | TX |