1255327029 NPI number — LA VIDA SERENA NURSING AND REHABILITATION LP

Table of content: (NPI 1255327029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255327029 NPI number — LA VIDA SERENA NURSING AND REHABILITATION LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA VIDA SERENA NURSING AND REHABILITATION 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:
Provider Other Organization Name Type Code:
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:
1255327029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 N ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76201-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-387-4388
Provider Business Mailing Address Fax Number:
940-380-2410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 KINGS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL RIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78840-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-774-0698
Provider Business Practice Location Address Fax Number:
830-774-0959
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RICH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
940-387-4388

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1109889 , 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: 155895901 . This is a "TMHP(DME CROSS OVER)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001004412 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155895902 . This is a "TMHP(CROSS OVER)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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