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General NPI Number Information
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NPI Number | 1558305672
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Entity Type | Organization
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Legal Business Name | BERTRAM DEVELOPMENT COMPANY INC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 540 HIGHWAY 29 EAST
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City | BERTRAM
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State | TX
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Zip | 78605-1615
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Country | US
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Telephone | 512-355-2116
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Fax | 512-355-2092
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Provider Business Mailing Address
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Address Line | PO BOX 1615
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City | BERTRAM
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State | TX
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Zip | 78605-1615
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Country | US
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Telephone | 512-355-2116
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Fax | 512-355-2092
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DENNIS RAY BAKER JR.
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Credential | LNFA
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Telephone | 512-355-2116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 115364
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License Number State | TX
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