Provider Demographics
NPI:1477953420
Name:MISSION BEND HEALTHCARE AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:MISSION BEND HEALTHCARE AND REHABILITATION, LLC
Other - Org Name:WEST HOUSTON REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-757-4987
Mailing Address - Street 1:8502 HUEBNER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2465
Mailing Address - Country:US
Mailing Address - Phone:210-757-4987
Mailing Address - Fax:210-694-4223
Practice Address - Street 1:13428 BISSONNET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083
Practice Address - Country:US
Practice Address - Phone:713-351-4300
Practice Address - Fax:713-351-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142335314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026405Medicaid
TX001026405Medicaid