Provider Demographics
NPI:1679091508
Name:SUMMIT LTC SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:SUMMIT LTC SAN ANTONIO, LLC
Other - Org Name:SUNRISE NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SLIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-681-4811
Mailing Address - Street 1:6050 SOUTHWEST BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4004
Mailing Address - Country:US
Mailing Address - Phone:817-681-4811
Mailing Address - Fax:
Practice Address - Street 1:50 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1267
Practice Address - Country:US
Practice Address - Phone:210-921-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility