Provider Demographics
NPI:1982921151
Name:ELITE LTC PROPERTIES OF BERTRAM LLC
Entity Type:Organization
Organization Name:ELITE LTC PROPERTIES OF BERTRAM LLC
Other - Org Name:BERTRAM NURSING ADN REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-992-2028
Mailing Address - Street 1:7429 AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6955
Mailing Address - Country:US
Mailing Address - Phone:817-595-4411
Mailing Address - Fax:
Practice Address - Street 1:540 E HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605-4473
Practice Address - Country:US
Practice Address - Phone:512-355-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility