Basic Information
Provider Information | |||||||||
NPI: | 1962573956 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | POST ACUTE MEDICAL AT LULING, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WARM SPRINGS SPECIALTY HOSPITAL OF LULING | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4660 TRINDLE RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | CAMP HILL | ||||||||
State: | PA | ||||||||
PostalCode: | 170115610 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7177308710 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 MEMORIAL DR | ||||||||
Address2: |   | ||||||||
City: | LULING | ||||||||
State: | TX | ||||||||
PostalCode: | 786483213 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8308758400 | ||||||||
FaxNumber: | 8308756899 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/13/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MISITANO | ||||||||
AuthorizedOfficialFirstName: | ANTHONY | ||||||||
AuthorizedOfficialMiddleName: | F | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 7177308710 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | 000184 | TX | Y |   | Hospitals | Special Hospital |   |
No ID Information.