Provider Demographics
NPI:1295020147
Name:PHCC-WINDMILL VILLAGE REHABILITATION & HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:PHCC-WINDMILL VILLAGE REHABILITATION & HEALTH CARE CENTER, LLC
Other - Org Name:WINDMILL VILLAGE REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-545-6320
Mailing Address - Street 1:19115 FM 2252
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2577
Mailing Address - Country:US
Mailing Address - Phone:210-545-6320
Mailing Address - Fax:210-545-2730
Practice Address - Street 1:507 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403-5211
Practice Address - Country:US
Practice Address - Phone:210-545-6320
Practice Address - Fax:210-545-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020457Medicaid
TX676318Medicare Oscar/Certification