Provider Demographics
NPI:1609945708
Name:BRONTE HEALTH AND REHAB CENTER
Entity Type:Organization
Organization Name:BRONTE HEALTH AND REHAB CENTER
Other - Org Name:EAST COKE COUNTY HOSPITAL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-473-3621
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:BRONTE
Mailing Address - State:TX
Mailing Address - Zip Code:76933-0407
Mailing Address - Country:US
Mailing Address - Phone:325-473-3621
Mailing Address - Fax:325-473-3472
Practice Address - Street 1:900 S. STATE ST
Practice Address - Street 2:
Practice Address - City:BRONTE
Practice Address - State:TX
Practice Address - Zip Code:76933-0407
Practice Address - Country:US
Practice Address - Phone:325-473-3621
Practice Address - Fax:325-473-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111713314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000490001Medicaid
TX67-5681Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX000490001Medicaid