Basic Information
| Provider Information | |||||||||
| NPI: | 1396098091 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OAKBEND MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINDSOR HOUSTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1705 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774693246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813414881 | ||||||||
| FaxNumber: | 2813413056 | ||||||||
| Practice Location | |||||||||
| Address1: | 6920 T.C. JESTER BLVD. | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770911509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136810431 | ||||||||
| FaxNumber: | 7136810433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | FREUDENBERGER | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2813414881 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 5642 | 05 | TX | MEDICAID | 001026717 | 05 | TX | MEDICAID | 001020965 | 05 | TX | MEDICAID |