Provider Demographics
NPI:1245272780
Name:PHCC-REHABILITATION AND HEALTH CARE CENTER AT BAYTOWN, LLC
Entity type:Organization
Organization Name:PHCC-REHABILITATION AND HEALTH CARE CENTER AT BAYTOWN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-545-6320
Mailing Address - Street 1:3921 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3307
Mailing Address - Country:US
Mailing Address - Phone:281-422-9541
Mailing Address - Fax:281-428-8528
Practice Address - Street 1:3921 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3307
Practice Address - Country:US
Practice Address - Phone:281-422-9541
Practice Address - Fax:281-428-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111942314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicaid