5423 Hamilton Wolfe Road Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

144843 Issued in TX

Legal business name

5423 HAMILTON WOLFE ROAD OPERATIONS LLC

Doing business as

PowerBack Rehabilitation San Antonio

Practice address

5423 Hamilton Wolfe Rd
San Antonio, TX 78229-4344

Phone

(210) 694-9494

NPI assigned

Mar 27, 2015

Organization subpart

Yes

Parent organization

SUMMIT CARE LLCAs reported in NPPES

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

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PowerBack Rehabilitation San Antonio Doing business as

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1124412077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5423 HAMILTON WOLFE RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294344",
            "telephone_number": "210-694-9494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5423 HAMILTON WOLFE RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294344",
            "telephone_number": "210-694-9494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "5423 HAMILTON WOLFE ROAD OPERATIONS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT CARE LLC",
        "enumeration_date": "2015-03-27",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "144843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001027706",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PowerBack Rehabilitation San Antonio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.