Provider Demographics
NPI:1942506357
Name:DENVER CITY REHAB & CARE
Entity Type:Organization
Organization Name:DENVER CITY REHAB & CARE
Other - Org Name:MERIDIAN LTC, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNALD
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:806-224-8948
Mailing Address - Street 1:315 N. MUSTANG DRIVE
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-3036
Mailing Address - Country:US
Mailing Address - Phone:806-592-2127
Mailing Address - Fax:806-592-5468
Practice Address - Street 1:315 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-3036
Practice Address - Country:US
Practice Address - Phone:806-592-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN LTC, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004993314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992010904OtherNPI
TX001018813Medicaid