Basic Information
| Provider Information | |||||||||
| NPI: | 1982921151 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELITE LTC PROPERTIES OF BERTRAM LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | BERTRAM NURSING ADN REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7429 AIRPORT FWY | ||||||||
| Address2: | |||||||||
| City: | RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761186955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175954411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 540 E HIGHWAY 29 | ||||||||
| Address2: | |||||||||
| City: | BERTRAM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786054473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123552116 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2010 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | HEAD | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8179922028 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.