=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588080519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELTERRA HEALTH & REHAB, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2014
-----------------------------------------------------
Last Update Date | 03/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2170 NORTH LAKE FOREST DRIVE
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-5156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-268-8103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2208 HIGHWAY 121 SUITE 180
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-5981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-268-8103
-----------------------------------------------------
Fax | 817-282-5967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MANAGER
-----------------------------------------------------
Name | DARREN M LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-268-8103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------