1295906444 NPI number — REGENT CARE SAN MARCOS B-3, LIMITED PARTNERSHIP

Table of content: (NPI 1295906444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295906444 NPI number — REGENT CARE SAN MARCOS B-3, LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENT CARE SAN MARCOS B-3, LIMITED PARTNERSHIP
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:
REGENT CARE CENTER OF SAN MARCOS
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:
1295906444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 SADLER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78666-7774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-805-5000
Provider Business Mailing Address Fax Number:
512-805-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 SADLER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666-7774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-763-6000
Provider Business Practice Location Address Fax Number:
409-770-0233
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OSTERMAYER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
409-763-6000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 103551 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001016217 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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