Southwest LTC Gulf Healthcare LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

005330 Issued in TX

Legal business name

SOUTHWEST LTC GULF HEALTHCARE LTD

Practice address

3702 Cove View Blvd
Galveston, TX 77554-8013

Phone

(409) 740-7330

Fax

(409) 407-7640

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

Mr. Ronald R Payne, ESQ.

Title

Ceo

Phone

(496) 916-6100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gulf Healthcare Center Galveston Doing business as

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": "1245224237",
    "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": "3702 COVE VIEW BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775548013",
            "telephone_number": "409-740-7330",
            "fax_number": "409-407-7640"
        }
    ],
    "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": "496-916-6100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "005330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5330",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Healthcare Center Galveston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mandi Lynn Sonnenfeld, PHD, OTR/L
• Joseph Sonstein, MD
• Lindsay Kay Sonstein, MD
• Mohamad Khaled Soufi, M.D
• Clarissa Breanne Sourada Cannon, M.A., LPC,NCC
• Samantha Kay Spears, MD
• Spiritspace, Inc.
• Erin Geordi Sreshta, M.D.
• Sathvik Srikalyani
• Adithya Srikanthan

• Skilled Nursing Facility in Galveston, TX
• Providers in Galveston, 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 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.