Provider Demographics
NPI:1225063639
Name:NATIONAL NURSING & REHAB, INC.
Entity Type:Organization
Organization Name:NATIONAL NURSING & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-822-0475
Mailing Address - Street 1:85 NE LOOP 410
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5866
Mailing Address - Country:US
Mailing Address - Phone:210-822-0457
Mailing Address - Fax:210-822-0485
Practice Address - Street 1:5926 S STAPLES ST
Practice Address - Street 2:SUITE C2
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3860
Practice Address - Country:US
Practice Address - Phone:361-225-3492
Practice Address - Fax:361-225-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00000251E00000X
TX007510251E00000X, 251J00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025192801Medicaid
TX025192801Medicaid