Provider Demographics
NPI:1376202234
Name:DEER PARK NURSING AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:DEER PARK NURSING AND REHAB CENTER LLC
Other - Org Name:SAN JACINTO MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-240-6408
Mailing Address - Street 1:206 W P ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4802
Mailing Address - Country:US
Mailing Address - Phone:281-479-8471
Mailing Address - Fax:
Practice Address - Street 1:206 W P ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4802
Practice Address - Country:US
Practice Address - Phone:801-601-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility