Provider Demographics
NPI:1366490856
Name:WEST SIDE CAMPUS OF CARE LP
Entity Type:Organization
Organization Name:WEST SIDE CAMPUS OF CARE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-493-3165
Mailing Address - Street 1:1950 LAS VEGAS TRAIL SOUTH
Mailing Address - Street 2:
Mailing Address - City:WHITE SETTLEMENT
Mailing Address - State:TX
Mailing Address - Zip Code:76108
Mailing Address - Country:US
Mailing Address - Phone:817-246-4995
Mailing Address - Fax:817-246-1025
Practice Address - Street 1:1950 LAS VEGAS TRAIL SOUTH
Practice Address - Street 2:
Practice Address - City:WHITE SETTLEMENT
Practice Address - State:TX
Practice Address - Zip Code:76108
Practice Address - Country:US
Practice Address - Phone:817-246-4995
Practice Address - Fax:817-246-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116174314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
455592Medicare ID - Type Unspecified