1083813497 NPI number — J-S FREDERICKSBURG OPERATIONS LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083813497 NPI number — J-S FREDERICKSBURG OPERATIONS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J-S FREDERICKSBURG OPERATIONS LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINDCREST NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083813497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 WATERS RIDGE DR
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-6011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-899-4401
Provider Business Mailing Address Fax Number:
972-899-4460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 W WINDCREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78624-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-997-7422
Provider Business Practice Location Address Fax Number:
830-997-0317
Provider Enumeration Date:
07/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICER
Authorized Official Telephone Number:
972-899-4401

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  121338 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001015160 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190698601 . This is a "MCD CO B" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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