1922044734 NPI number — TRANSITIONAL LEARNING CENTER AT GALVESTON

Table of content: (NPI 1922044734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922044734 NPI number — TRANSITIONAL LEARNING CENTER AT GALVESTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSITIONAL LEARNING CENTER AT GALVESTON
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:
MOODY NEUROREHABILITATION INSTITUTE
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:
1922044734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1528 POSTOFFICE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-762-6661
Provider Business Mailing Address Fax Number:
409-763-3430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1528 POSTOFFICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-762-6661
Provider Business Practice Location Address Fax Number:
409-763-3430
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DECKER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
409-762-6661

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 140773 , 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: 150287 . This is a "TEXAS HEALTH & HUMAN SERVICES ASSISTED LIVING FACILITY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 149997 . This is a "TEXAS HEALTH & HUMAN SERVICES ASSISTED LIVING FACILITY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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