Organization
PERMIAN BASIN REHABILITATION CENTER FOR CRIPPLED CHILDREN AND ADULTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY RUBY ORTEGA (EXECUTIVE DIRECTOR)
(432) 332-8244
Entity
Organization
Contact information
Practice address
620 N ALLEGHANEY AVE, ODESSA, TX 79761-4408
(432) 332-8244
(432) 580-7428
Mailing address
620 N ALLEGHANEY AVE, ODESSA, TX 79761-4408
(432) 332-8244
(432) 580-7428
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051CT
BCBS GROUP NUMBER
TX
05
—
094460501
—
TX
01
—
531269
BCBS HEARING AID ID NUM
TX
01
—
5589378
AETNA BILLING NUM
TX
Enumeration date
03/09/2007
Last updated
02/10/2025
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