Basic Information
Provider Information
NPI: 1922040468
EntityType: 2
ReplacementNPI:  
OrganizationName: PHCC-PARAMOUNT REHABILITATION AND HEALTH CARE CENTER SAN ANTONIO, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PARAMOUNT REHABILITATION AND HEALTHCARE CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5437 EISENHAUER RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782183757
CountryCode: US
TelephoneNumber: 2106469576
FaxNumber: 2106533695
Practice Location
Address1: 5437 EISENHAUER RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782183757
CountryCode: US
TelephoneNumber: 2106469576
FaxNumber: 2106533695
Other Information
ProviderEnumerationDate: 06/11/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MEYERS
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName: ARTHUR
AuthorizedOfficialTitleorPosition: PRESIDENT, CFO
AuthorizedOfficialTelephone: 2105456320
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: JR.
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X100297TXY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
PENDING05TX MEDICAID


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