Provider Demographics
NPI:1821233941
Name:GRANITE MESA HEALTH CENTER, LTD.
Entity Type:Organization
Organization Name:GRANITE MESA HEALTH CENTER, LTD.
Other - Org Name:GRANITE MESA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORABIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-693-0022
Mailing Address - Street 1:1301 SOUTH MOPAC
Mailing Address - Street 2:FOUR BARTON SKYWAY, SUITE 320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6921
Mailing Address - Country:US
Mailing Address - Phone:512-703-2210
Mailing Address - Fax:512-703-2050
Practice Address - Street 1:1401 MAX COPELAND DRIVE
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4665
Practice Address - Country:US
Practice Address - Phone:830-693-0022
Practice Address - Fax:830-693-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016519Medicaid
TX676220Medicare Oscar/Certification