Provider Demographics
NPI:1225293855
Name:MASON FRIENDSWOOD OP LLC
Entity Type:Organization
Organization Name:MASON FRIENDSWOOD OP LLC
Other - Org Name:FRIENDSHIP HAVEN HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-992-4300
Mailing Address - Street 1:1500 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4724
Mailing Address - Country:US
Mailing Address - Phone:281-992-4300
Mailing Address - Fax:281-992-0964
Practice Address - Street 1:1500 SUNSET DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4724
Practice Address - Country:US
Practice Address - Phone:281-992-4300
Practice Address - Fax:281-992-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132738314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016220Medicaid
TX004286OtherFACILITY ID
675744Medicare Oscar/Certification