Provider Demographics
NPI:1245315647
Name:NORTH BAY GENERAL HOSPITAL, INC.
Entity type:Organization
Organization Name:NORTH BAY GENERAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-758-0502
Mailing Address - Street 1:1711 W WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4536
Mailing Address - Country:US
Mailing Address - Phone:361-758-8585
Mailing Address - Fax:361-758-3547
Practice Address - Street 1:1711 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-758-8585
Practice Address - Fax:361-758-3547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100053273R00000X, 275N00000X, 276400000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1218455-03Medicaid
HH0596OtherBC/BS
TX0225187-01Medicaid
TX0209330-01Medicaid
HH3596OtherBC/BS PSYCH
HH0596OtherBC/BS
HH3596OtherBC/BS PSYCH
TX0225187-01Medicaid