Provider Demographics
NPI:1972677540
Name:GERIATRIC CARE OF TEXAS, INC
Entity Type:Organization
Organization Name:GERIATRIC CARE OF TEXAS, INC
Other - Org Name:CYPRESS WOODS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS-WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:979-849-8221
Mailing Address - Street 1:135 1/2 E HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4111
Mailing Address - Country:US
Mailing Address - Phone:979-849-8221
Mailing Address - Fax:979-849-1941
Practice Address - Street 1:135 1/2 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4111
Practice Address - Country:US
Practice Address - Phone:979-849-8221
Practice Address - Fax:979-849-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114686314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000484204Medicaid
TX675556Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER