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NPI Code Detail

MEDICARE: ST TERESA NURSING AND REHABILITATION CENTER, LLC

MEDICARE: ST TERESA NURSING AND REHABILITATION CENTER, LLC
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
1314000000XSkilled Nursing FacilityTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356788897
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST TERESA NURSING AND REHABILITATION CENTER, LLC
Provider Business Mailing Address
First Line : 10350 MONTANA AVENUE
Second Line :
City : EL PASO
State : TX
Zip : 79925-1602
Country : US
Telephone Number : 915-595-6137
Fax Number : 915-595-6186
Provider Business Practice Location Address
First Line : 10350 MONTANA AVENUE
Second Line :
City : EL PASO
State : TX
Zip : 79925-1602
Country : US
Telephone Number : 915-595-6137
Fax Number : 915-595-6186
Authorized Official
Title or Position : C F O
Name : SHAWN CONLEY
Credential :
Telephone Number : 817-332-3030
Provider Enumeration Date : 05/23/2013
Last Update Date : 01/14/2014

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