Provider Demographics
NPI:1376540377
Name:TWIN PINES NURSING & REHABILIATATION INC.
Entity Type:Organization
Organization Name:TWIN PINES NURSING & REHABILIATATION INC.
Other - Org Name:TWIN PINES NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:LNFA
Authorized Official - Phone:361-576-9454
Mailing Address - Street 1:PO BOX 7230
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-7230
Mailing Address - Country:US
Mailing Address - Phone:361-576-9454
Mailing Address - Fax:361-576-2994
Practice Address - Street 1:3301 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2437
Practice Address - Country:US
Practice Address - Phone:361-573-3201
Practice Address - Fax:361-485-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110912314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4975Medicaid
TX001012474Medicaid
TX094556003Medicaid
TX094556003Medicaid
TX4975Medicaid
TX=========OtherTIN NUMBER
TX675638Medicare Oscar/Certification