Healthcare Provider Details

I. General information

NPI: 1336229798
Provider Name (Legal Business Name): BRENHAM HEALTH CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 COTTONWOOD ST
BRENHAM TX
77833-3237
US

IV. Provider business mailing address

1020 NE LOOP 410 SUITE #650
SAN ANTONIO TX
78209-1204
US

V. Phone/Fax

Practice location:
  • Phone: 979-836-3434
  • Fax: 979-836-3461
Mailing address:
  • Phone: 210-828-5686
  • Fax: 210-824-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number105157
License Number StateTX

VIII. Authorized Official

Name: MR. CARL FELLBAUM
Title or Position: PRESIDENT
Credential:
Phone: 210-828-5686