1174520613 NPI number — TEXAN NURSING AND REHAB OF GONZALES LLC

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 1174520613 NPI number — TEXAN NURSING AND REHAB OF GONZALES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAN NURSING AND REHAB OF GONZALES 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:
Provider Other Organization Name Type Code:
6
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:
1174520613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
3428 MOULTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GONZALES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78629-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-672-2867
Provider Business Practice Location Address Fax Number:
830-672-6483
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:
PRESIDENT
Authorized Official Telephone Number:
210-572-0701

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  109231 , 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)





Copyright © 2007-2025 www.npivalidator.com