Basic Information
| Provider Information | |||||||||
| NPI: | 1477953420 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MISSION BEND HEALTHCARE AND REHABILITATION, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WEST HOUSTON REHABILITATION AND HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8502 HUEBNER RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782402465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107574987 | ||||||||
| FaxNumber: | 2106944223 | ||||||||
| Practice Location | |||||||||
| Address1: | 13428 BISSONNET | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133514300 | ||||||||
| FaxNumber: | 7133514301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | CRANK | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2107574987 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 142335 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001026405 | 05 | TX | MEDICAID |