Provider Demographics
NPI:1407865041
Name:REGENCY NURSING CENTER PARTNERS OF WHARTON, LTD
Entity Type:Organization
Organization Name:REGENCY NURSING CENTER PARTNERS OF WHARTON, LTD
Other - Org Name:WHARTON NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HEBER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0694
Mailing Address - Street 1:1220 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3300
Mailing Address - Country:US
Mailing Address - Phone:979-532-5020
Mailing Address - Fax:979-532-8853
Practice Address - Street 1:1220 SUNNY LN
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3300
Practice Address - Country:US
Practice Address - Phone:979-532-5020
Practice Address - Fax:979-532-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118478313M00000X
TX675361314000000X
TX5806140001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014451Medicaid
TX143533101Medicaid
TX185963901Medicaid
TX4115Medicaid
TX185963901Medicaid
TX4115Medicaid