Provider Demographics
NPI:1508288325
Name:VILLA DEL MAR AT MAINLAND CENTER
Entity Type:Organization
Organization Name:VILLA DEL MAR AT MAINLAND CENTER
Other - Org Name:THE RIO AT MAINLAND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-767-7238
Mailing Address - Street 1:2150 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4070
Mailing Address - Country:US
Mailing Address - Phone:469-767-7238
Mailing Address - Fax:
Practice Address - Street 1:1011 MAINLAND CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2666
Practice Address - Country:US
Practice Address - Phone:713-358-0700
Practice Address - Fax:713-358-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025697Medicaid
TX676360Medicare Oscar/Certification