Provider Demographics
NPI:1467901306
Name:CITY OF ENNIS
Entity Type:Organization
Organization Name:CITY OF ENNIS
Other - Org Name:STERLING OAKS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-875-1234
Mailing Address - Street 1:25150 LAKECREST MANOR DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3184
Mailing Address - Country:US
Mailing Address - Phone:281-347-8200
Mailing Address - Fax:
Practice Address - Street 1:25150 LAKECREST MANOR DRIVE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3184
Practice Address - Country:US
Practice Address - Phone:281-347-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001028448Medicaid