MEDICARE: POMERADO RANCH HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		TX

General Provider Information

NPI Number	:	1295975084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMERADO RANCH HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1615 HILLENDAHL ROAD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3413
Country	:	US
Telephone Number	:	713-365-0561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 HILLENDAHL ROAD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3413
Country	:	US
Telephone Number	:	713-365-0561
Fax Number	:	713-365-9742

Authorized Official
Title or Position	:	TREASURER
Name	:	MS. SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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