Provider Demographics
NPI:1639176175
Name:TEXAN NURSING & REHAB OF AMARILLO LLC
Entity Type:Organization
Organization Name:TEXAN NURSING & REHAB OF AMARILLO LLC
Other - Org Name:TAMARILLOAMARILLO NURSING CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:REEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-572-0701
Mailing Address - Street 1:1919 OAKWELL FARMS PKWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1777
Mailing Address - Country:US
Mailing Address - Phone:210-572-0701
Mailing Address - Fax:210-572-1422
Practice Address - Street 1:4033 W 51ST AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6129
Practice Address - Country:US
Practice Address - Phone:806-355-4488
Practice Address - Fax:806-353-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014443Medicaid
TX000434808Medicaid
TX000434808Medicaid