Provider Demographics
NPI:1922044734
Name:TRANSITIONAL LEARNING CENTER AT GALVESTON
Entity Type:Organization
Organization Name:TRANSITIONAL LEARNING CENTER AT GALVESTON
Other - Org Name:MOODY NEUROREHABILITATION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-762-6661
Mailing Address - Street 1:1528 POSTOFFICE ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550
Mailing Address - Country:US
Mailing Address - Phone:409-762-6661
Mailing Address - Fax:409-763-3430
Practice Address - Street 1:1528 POSTOFFICE ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-762-6661
Practice Address - Fax:409-763-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0401X, 3104A0625X
TX140773310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150287OtherTEXAS HEALTH & HUMAN SERVICES ASSISTED LIVING FACILITY LICENSE
TX149997OtherTEXAS HEALTH & HUMAN SERVICES ASSISTED LIVING FACILITY LICENSE