1639176175 NPI number — TEXAN NURSING & REHAB OF AMARILLO LLC

Table of content: (NPI 1639176175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639176175 NPI number — TEXAN NURSING & REHAB OF AMARILLO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAN NURSING & REHAB OF AMARILLO LLC
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:
TAMARILLOAMARILLO NURSING CENTER, INC
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:
1639176175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 OAKWELL FARMS PKWY
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78218-1777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-572-0701
Provider Business Mailing Address Fax Number:
210-572-1422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4033 W 51ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79109-6129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-4488
Provider Business Practice Location Address Fax Number:
806-353-0885
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REEH
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
210-572-0701

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  111068 , 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: 001014443 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000434808 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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