NPIMap

Organization Active NPI

Southbrooke Manor Nursing and Rehabilitation Center, Inc

Doing business as Southbrooke Manor Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Edna, TX
National Provider Identifier
1285697763
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
675159 Issued in TX
Legal business name
SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC
Doing business as
Southbrooke Manor Nursing and Rehabilitation Center
Practice address
1401 W Main St
Edna, TX 77957-2454
Phone
(361) 782-7614
Fax
(361) 782-5612
NPI assigned
Apr 7, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Heber S Lacerda
Title
President/Ceo
Phone
(361) 576-0694

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 115308 TX
Skilled Nursing Facility 314000000X 675159 TX Primary
Durable Medical Equipment & Medical Supplies 332B00000X 1005880001 TX

Addresses

Primary practice location

1401 W Main St
Edna, TX 77957-2454

Mailing address

1401 W Main St
Edna, TX 77957-2454
Phone (361) 782-7614

Other identifiers 2

IdentifierTypeStateIssuer
HH045SOtherTXBCBS BLUELINK
530201MedicaidTX

Other names 1

  • SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Citizens Medical Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1285697763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 W MAIN ST",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779572454",
            "telephone_number": "361-782-7614",
            "fax_number": "361-782-5612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W MAIN ST",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779572454",
            "telephone_number": "361-782-7614",
            "fax_number": "361-782-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LACERDA",
        "authorized_official_first_name": "HEBER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "361-576-0694",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "115308",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "675159",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "1005880001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BLUELINK",
            "identifier": "HH045S",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "530201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edna, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.