Provider Demographics
NPI:1295777902
Name:WEST 380 NURSING CENTER
Entity type:Organization
Organization Name:WEST 380 NURSING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-683-5283
Mailing Address - Street 1:2108 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426
Mailing Address - Country:US
Mailing Address - Phone:940-683-5023
Mailing Address - Fax:940-683-3184
Practice Address - Street 1:2108 15TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426
Practice Address - Country:US
Practice Address - Phone:940-683-5023
Practice Address - Fax:940-683-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014008Medicaid
TX675891Medicare ID - Type UnspecifiedMEDICARE