Southwest LTC Gulf Healthcare LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

005322 Issued in TX

Legal business name

SOUTHWEST LTC GULF HEALTHCARE LTD

Practice address

6600 9TH Ave
Port Arthur, TX 77642-6411

Phone

(469) 916-6100

Fax

(469) 916-6105

NPI assigned

Sep 6, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald R Payne, ESQ.

Title

Ceo

Phone

(469) 916-6100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gulf Healthcare Center Port Arthur Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1023002102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1518 LEGACY DR",
            "address_2": "SUITE 110",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750346038",
            "telephone_number": "469-916-6100",
            "fax_number": "469-916-6105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 9TH AVE",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "776426411",
            "telephone_number": "469-916-6100",
            "fax_number": "469-916-6105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC GULF HEALTHCARE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-916-6100",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "005322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5322",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Healthcare Center Port Arthur",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Port Arthur, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.