Provider Demographics
NPI:1427044585
Name:KNOPP NURSING & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:KNOPP NURSING & REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUCKENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:830-997-8840
Mailing Address - Street 1:202 BILLIE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5056
Mailing Address - Country:US
Mailing Address - Phone:830-997-8840
Mailing Address - Fax:830-997-5310
Practice Address - Street 1:202 BILLIE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5056
Practice Address - Country:US
Practice Address - Phone:830-997-8840
Practice Address - Fax:830-997-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114733313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675740Medicare ID - Type Unspecified