Provider Demographics
NPI:1508318502
Name:NATIONAL NURSING & REHAB INC
Entity Type:Organization
Organization Name:NATIONAL NURSING & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-822-0475
Mailing Address - Street 1:85 NE LOOP 410
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5866
Mailing Address - Country:US
Mailing Address - Phone:210-822-0457
Mailing Address - Fax:210-822-0485
Practice Address - Street 1:5926 S STAPLES ST
Practice Address - Street 2:SUITE C2
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3860
Practice Address - Country:US
Practice Address - Phone:361-225-3492
Practice Address - Fax:361-225-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017539251E00000X, 251J00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care