Provider Demographics
NPI:1356471650
Name:FORT BEND LTC CORPORATION
Entity Type:Organization
Organization Name:FORT BEND LTC CORPORATION
Other - Org Name:FORT BEND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-993-9406
Mailing Address - Street 1:3613 W ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5905
Mailing Address - Country:US
Mailing Address - Phone:713-993-9406
Mailing Address - Fax:713-993-9855
Practice Address - Street 1:3010 BAMORE RD
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5712
Practice Address - Country:US
Practice Address - Phone:281-342-2142
Practice Address - Fax:281-342-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675663Medicare Oscar/Certification