Ponderosa Nursing and Rehabiliation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

001021048 Issued in TX

Legal business name

PONDEROSA NURSING AND REHABILIATION

Practice address

12520 FM 1840
De Kalb, TX 75559-1929

Phone

(903) 667-2572

NPI assigned

Oct 17, 2016

Organization subpart

No

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

Authorized official

Name

Beverly Hagood, LNFA

Title

Administator

Phone

(903) 667-2572

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1376094284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12520 FM 1840",
            "city": "DE KALB",
            "state": "TX",
            "postal_code": "755591929",
            "telephone_number": "903-667-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12520 FM 1840",
            "city": "DE KALB",
            "state": "TX",
            "postal_code": "755591929",
            "telephone_number": "903-667-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA NURSING AND REHABILIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "HAGOOD",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "ADMINISTATOR",
        "authorized_official_telephone_number": "903-667-2572",
        "authorized_official_credential": "LNFA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "001021048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001021048",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lee Alison McCrary, APRN, NP-C
• Janet Marlene Moreland, PA
• Nacogdoches County Hospital District
• Patient Access Foundation
• Myron Patrick
• Tracy Ratliff, NP
• Amy Nicole Rowan
• Cody Jo Sanford, APRN
• Dale Kay Shelton, FNP-BC
• The Optical Shoppe

• Skilled Nursing Facility in De Kalb, TX
• Providers in De Kalb, 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 17, 2016; 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.