Healthcare Provider Details

I. General information

NPI: 1679955843
Provider Name (Legal Business Name): TIMBERIDGE NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W GIBSON ST
JASPER TX
75951-4903
US

IV. Provider business mailing address

315 W GIBSON ST
JASPER TX
75951-4903
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-5768
  • Fax: 409-381-8774
Mailing address:
  • Phone: 409-384-5768
  • Fax: 409-381-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JACK H SANDERS
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-590-0007