Provider Demographics
NPI:1083793822
Name:TRISTAR CARE CENTER, INC.
Entity Type:Organization
Organization Name:TRISTAR CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-698-9010
Mailing Address - Street 1:2704 BLACKSTONE CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7892
Mailing Address - Country:US
Mailing Address - Phone:512-698-9010
Mailing Address - Fax:512-310-0631
Practice Address - Street 1:619 W LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4415
Practice Address - Country:US
Practice Address - Phone:830-997-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676075Medicare ID - Type UnspecifiedMEDICARE