Provider Demographics
NPI:1558305672
Name:BERTRAM DEVELOPMENT COMPANY INC
Entity Type:Organization
Organization Name:BERTRAM DEVELOPMENT COMPANY INC
Other - Org Name:BERTRAM NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LNFA
Authorized Official - Phone:512-355-2116
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:BERTRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78605-1615
Mailing Address - Country:US
Mailing Address - Phone:512-355-2116
Mailing Address - Fax:512-355-2092
Practice Address - Street 1:540 HIGHWAY 29 EAST
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605-1615
Practice Address - Country:US
Practice Address - Phone:512-355-2116
Practice Address - Fax:512-355-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115364313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00452202OtherVENDOR NUMBER
TX00452202OtherVENDOR NUMBER