Provider Demographics
NPI:1447414156
Name:GAZEBO TERRACE CONVALESCENT CENTER
Entity Type:Organization
Organization Name:GAZEBO TERRACE CONVALESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:L
Authorized Official - Last Name:POHLMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-830-7100
Mailing Address - Street 1:1303 HIGHWAY 290 E
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5928
Mailing Address - Country:US
Mailing Address - Phone:979-830-7100
Mailing Address - Fax:979-830-0820
Practice Address - Street 1:1303 HIGHWAY 290 E
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5928
Practice Address - Country:US
Practice Address - Phone:979-830-7100
Practice Address - Fax:979-830-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122969313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility