MEDICARE: NEXION HEALTH AT BOGATA, 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	114691	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	004267	OTHER	TX	STATE VENDOR NUMBER

General Provider Information

NPI Number	:	1699736421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXION HEALTH AT BOGATA, INC.

Provider Business Mailing Address
First Line	:	6937 WARFIELD AVE
Second Line	:
City	:	SYKESVILLE
State	:	MD
Zip	:	21784-7454
Country	:	US
Telephone Number	:	410-552-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 W MAIN ST
Second Line	:
City	:	CLARKSVILLE
State	:	TX
Zip	:	75426-3327
Country	:	US
Telephone Number	:	903-427-3821
Fax Number	:	903-427-5111

Authorized Official
Title or Position	:	CEO
Name	:	FRANCIS P KIRLEY
Credential	:
Telephone Number	:	410-552-4800

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/04/2016

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