Provider Demographics
NPI:1548542830
Name:CPRH I LLC
Entity type:Organization
Organization Name:CPRH I LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-906-3700
Mailing Address - Street 1:5726 ESPLANADE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4165
Mailing Address - Country:US
Mailing Address - Phone:361-906-3700
Mailing Address - Fax:361-985-0519
Practice Address - Street 1:5726 ESPLANADE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4165
Practice Address - Country:US
Practice Address - Phone:361-906-3700
Practice Address - Fax:361-985-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100141OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES
522774OtherJOINT COMMISSION
TX673053Medicare PIN