Healthcare Provider Details

I. General information

NPI: 1477879401
Provider Name (Legal Business Name): PHCC-BRODIE RANCH REHABILITATION & HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FRATE BARKER ROAD
AUSTIN TX
78748-3614
US

IV. Provider business mailing address

19115 FM 2252 SUITE 1
GARDEN RIDGE TX
78266-2577
US

V. Phone/Fax

Practice location:
  • Phone: 210-545-6320
  • Fax: 210-545-2730
Mailing address:
  • Phone: 210-545-6320
  • Fax: 210-545-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPENDING
License Number StateTX

VIII. Authorized Official

Name: MR. JAMES A. MEYERS JR.
Title or Position: MANAGER
Credential:
Phone: 210-545-6320