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Organization
LAGUNA MADRE REHABILITATION CENTER INC
Active
Organization
LAGUNA MADRE REHABILITATION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO OLIVAS (OWNER)
(512) 644-7368
Entity
Organization
Contact information
Practice address
14121 W HWY 290 STE 2B, AUSTIN, TX 78737-9397
(512) 644-7368
Mailing address
561 MANCHESTER LN, AUSTIN, TX 78737-4543
(512) 644-7368
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297413101
—
TX
01
—
297413102
CSHCN#
TX
Enumeration date
04/04/2012
Last updated
03/17/2018
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