Healthcare Provider Details

I. General information

NPI: 1124290150
Provider Name (Legal Business Name): PREMONT REHAB AND NURSING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 NW 3RD STREET
PREMONT TX
78375-0260
US

IV. Provider business mailing address

401 N CARROLL AVE # 157
SOUTHLAKE TX
76092-6407
US

V. Phone/Fax

Practice location:
  • Phone: 361-348-3553
  • Fax:
Mailing address:
  • Phone: 817-992-2028
  • Fax:

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: JEFFREY A HEAD
Title or Position: PRESIDENT
Credential:
Phone: 817-992-2028