Provider Demographics
NPI:1003813742
Name:BAYLOR INSTITUTE FOR REHABILITATION AT GASTON EPISCOPAL HOSPITAL
Entity Type:Organization
Organization Name:BAYLOR INSTITUTE FOR REHABILITATION AT GASTON EPISCOPAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCMULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-820-9505
Mailing Address - Street 1:PO BOX 847093
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7093
Mailing Address - Country:US
Mailing Address - Phone:214-820-1538
Mailing Address - Fax:214-820-7950
Practice Address - Street 1:909 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1520
Practice Address - Country:US
Practice Address - Phone:214-820-9300
Practice Address - Fax:214-820-9295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000642283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112721902Medicaid
TX112721902Medicaid