Provider Demographics
NPI:1013972447
Name:ELGIN GOLDEN YEARS NURSING AND REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:ELGIN GOLDEN YEARS NURSING AND REHABILITATION CENTER, INC
Other - Org Name:ELGIN GOLDEN YEARS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEBER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0694
Mailing Address - Street 1:605 HWY 290
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-2510
Mailing Address - Country:US
Mailing Address - Phone:512-281-3413
Mailing Address - Fax:512-281-3016
Practice Address - Street 1:605 HWY 290
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2510
Practice Address - Country:US
Practice Address - Phone:512-281-3413
Practice Address - Fax:512-281-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115129313M00000X
TX675725314000000X
TX1225160001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX445301Medicaid
TXHH037SOtherBCBS BLUE LINK
TX=========OtherEGY, INC EIN
TX1225160001Medicare NSC
TX=========OtherEGY, INC EIN