Provider Demographics
NPI:1356497010
Name:ST. JAMES HOUSE OF BAYTOWN
Entity Type:Organization
Organization Name:ST. JAMES HOUSE OF BAYTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-425-1227
Mailing Address - Street 1:5800 W BAKER RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1618
Mailing Address - Country:US
Mailing Address - Phone:281-425-1200
Mailing Address - Fax:281-424-1922
Practice Address - Street 1:5800 W BAKER RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1618
Practice Address - Country:US
Practice Address - Phone:281-425-1200
Practice Address - Fax:281-424-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117511314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000468201Medicaid
TX282N00000XOtherTAXONOMY NUMBER
TX117511OtherTDADS LICENSE NUMBER
TX675999Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER