Provider Demographics
NPI:1003842642
Name:BAY AREA REHABILITATION CENTER
Entity type:Organization
Organization Name:BAY AREA REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-838-4477
Mailing Address - Street 1:5313 DECKER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1413
Mailing Address - Country:US
Mailing Address - Phone:281-838-4477
Mailing Address - Fax:281-838-3465
Practice Address - Street 1:5313 DECKER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1413
Practice Address - Country:US
Practice Address - Phone:281-838-4477
Practice Address - Fax:281-838-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD1600X, 261QR0400X
TX6052400261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021258101Medicaid
TX091741101Medicaid
TX676753OtherMEDICARE CCN
TX142522501Medicaid
TX=========OtherTAX ID#