Provider Demographics
NPI:1952356370
Name:GOLDEN MANOR JEWISH HOME FOR THE AGED
Entity type:Organization
Organization Name:GOLDEN MANOR JEWISH HOME FOR THE AGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-736-4544
Mailing Address - Street 1:130 SPENCER LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2109
Mailing Address - Country:US
Mailing Address - Phone:210-736-4544
Mailing Address - Fax:210-732-4035
Practice Address - Street 1:130 SPENCER LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2109
Practice Address - Country:US
Practice Address - Phone:210-736-4544
Practice Address - Fax:210-732-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117389314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-5690Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.