Little Lighthouse Children's Rehab., LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

LITTLE LIGHTHOUSE CHILDREN'S REHAB., LLC

Practice address

503 W Ocean Blvd
Suite B
Los Fresnos, TX 78566-3635

Phone

(956) 797-2100

Fax

(956) 797-0000

NPI assigned

Sep 12, 2007

Last updated

Sep 12, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ricardo Perez, SLP

Title

Owner

Phone

(956) 792-3277

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740475706. Details of each certification follow.

• CCN 676601 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 676601

Legal name

LITTLE LIGHTHOUSE CHILDREN'S REHAB LLC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jun 8, 2005

Last certification

May 2, 2016

Ownership / control type

Proprietary

Facility address

503 W Ocean Blvd, Ste B
Los Fresnos, TX 78566

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Little Lighthouse Children's Rehab., LLC

  • Rehabilitation Clinic/Center
  • La Feria, TX
  • NPI 1316132483

  O20050317000328

  Same enrollment
• Little Lighthouse Childrens Rehab

  • Rehabilitation Clinic/Center
  • Los Fresnos, TX
  • NPI 1942398151

  O20050317000328

  Same enrollment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1740475706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 W OCEAN BLVD",
            "address_2": "SUITE B",
            "city": "LOS FRESNOS",
            "state": "TX",
            "postal_code": "785663635",
            "telephone_number": "956-797-2100",
            "fax_number": "956-797-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 W OCEAN BLVD",
            "address_2": "SUITE B",
            "city": "LOS FRESNOS",
            "state": "TX",
            "postal_code": "785663635",
            "telephone_number": "956-797-2100",
            "fax_number": "956-797-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE LIGHTHOUSE CHILDREN'S REHAB., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-792-3277",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Kay Marie Klassen, RN, FNP-BC, ARNP,
• Lisa Christina Krawczynski, RPH
• Joy Anne Faye Kroes, M.D.
• Adam Michael Lalonde, DDS
• Juan Manuel Leyva Jr., FNP-BC
• Little Lighthouse Childrens Rehab
• Ivania Vianey Longoria Dorado
• Shaidy Lopez, OTR
• Los Fresnos Ambulance Service, Inc
• Los Fresnos Cisd

• Rehabilitation Clinic/Center in Los Fresnos, TX
• Providers in Los Fresnos, TX by specialty
• Rehabilitation Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.