Basic Information
| Provider Information | |||||||||
| NPI: | 1194969782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUNCTION LONG TERM CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOMESTEAD NURSING AND REHABILITATION OF JUNCTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 TEXAS PT | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782607738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103167790 | ||||||||
| FaxNumber: | 2104972497 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | JUNCTION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768493020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103167790 | ||||||||
| FaxNumber: | 2104972497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 04/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | BYERS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | LAIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2103167790 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 004838 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001000624 | 05 | TX | MEDICAID |