Provider Demographics
NPI:1538114525
Name:NAZARETH HALL
Entity Type:Organization
Organization Name:NAZARETH HALL
Other - Org Name:NAZARETH LIVING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-565-4677
Mailing Address - Street 1:1475 RAYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3122
Mailing Address - Country:US
Mailing Address - Phone:915-565-4677
Mailing Address - Fax:915-565-5118
Practice Address - Street 1:1475 RAYNOLDS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3122
Practice Address - Country:US
Practice Address - Phone:915-565-4677
Practice Address - Fax:915-565-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123868314000000X
TX0099750332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000485901Medicaid
675723Medicare ID - Type Unspecified
TX000485901Medicaid