1821233941 NPI number — GRANITE MESA HEALTH CENTER, LTD.

Table of content: (NPI 1821233941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821233941 NPI number — GRANITE MESA HEALTH CENTER, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANITE MESA HEALTH CENTER, LTD.
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:
1821233941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 SOUTH MOPAC
Provider Second Line Business Mailing Address:
FOUR BARTON SKYWAY, SUITE 320
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-703-2210
Provider Business Mailing Address Fax Number:
512-703-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 MAX COPELAND DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARBLE FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78654-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-693-0022
Provider Business Practice Location Address Fax Number:
830-693-2322
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HORABIN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-693-0022

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 001016519 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com