Active NPI
Eagle'S Trace Inc
- Rehabilitation Clinic/Center
- Houston, TX
National Provider Identifier
1174601447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Clinic/Center
- License
- 660930000
- Legal business name
- EAGLE'S TRACE INC
- Practice address
- 14703 Eagle Vista Drive
Attn: Rehabilitation MGR
Houston, TX 77077-5394 - Phone
- (281) 249-7000
- Fax
- (410) 204-7237
- NPI assigned
- Nov 2, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- James K Walter
- Title
- Finance Director
- Phone
- (410) 402-2315
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | 660930000 | TX | Primary |
Addresses
Primary practice location
14703 Eagle Vista Drive
Attn: Rehabilitation MGR
Houston, TX 77077-5394
Mailing address
14703 Eagle Vista Drive
Attn: Executive Director
Houston, TX 77077-5394
Phone (281) 249-7000
Other names 1
- Outpatient Rehabilitation Agency at Eagle's Trace
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070103000117 | TX | Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 2466452164 | Practice locations: Houston, TX |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Continuing Care at Eagle'S Trace
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Houston, TX
- NPI 1144580192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1403222400000",
"number": "1174601447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14703 EAGLE VISTA DRIVE",
"address_2": "ATTN: EXECUTIVE DIRECTOR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770775394",
"telephone_number": "281-249-7000",
"fax_number": "410-204-7237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14703 EAGLE VISTA DRIVE",
"address_2": "ATTN: REHABILITATION MGR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770775394",
"telephone_number": "281-249-7000",
"fax_number": "410-204-7237"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAGLE'S TRACE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-02",
"last_updated": "2014-06-20",
"status": "A",
"authorized_official_last_name": "WALTER",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "FINANCE DIRECTOR",
"authorized_official_telephone_number": "410-402-2315"
},
"taxonomies": [
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": "TX",
"license": "660930000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Outpatient Rehabilitation Agency at Eagle's Trace",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.