Provider Demographics
NPI:1639259179
Name:ARBORETUM HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ARBORETUM HEALTH CARE, INC.
Other - Org Name:RENAISSANCE VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLBAURM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-828-5686
Mailing Address - Street 1:210 W NOTTINGHAM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-828-5686
Mailing Address - Fax:210-824-4669
Practice Address - Street 1:700 DYER ST
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2208
Practice Address - Country:US
Practice Address - Phone:512-446-2548
Practice Address - Fax:512-446-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115207314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000418403Medicaid
TX676093Medicare Oscar/Certification