Gardendale SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GARDENDALE SNF LLC

Doing business as

Gardendale Rehabilitation & Nursing Center

Practice address

1521 E Rusk St
Jacksonville, TX 75766-5505

Phone

(903) 586-3626

NPI assigned

Oct 19, 2009

Last updated

Oct 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Zevi Kohn

Title

Cfo

Phone

(917) 370-9063

Specialties & licenses 2

Addresses

Other names 1

• Gardendale Rehabilitation & Nursing Center Doing business as

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255910400000",
    "number": "1437485935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 E RANDOL MILL RD",
            "address_2": "STE630",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760116315",
            "telephone_number": "817-607-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757665505",
            "telephone_number": "903-586-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDENDALE SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-19",
        "last_updated": "2009-10-19",
        "status": "A",
        "authorized_official_last_name": "KOHN",
        "authorized_official_first_name": "ZEVI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "917-370-9063"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gardendale Rehabilitation & Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Fitzpatrick, M.D.
• Larry Lofton Folden, D.D.S.
• Ryan Dean Ford, M.D.
• Gardendale HH Opco LLC (Gardendale Healthcare Residence)
• Gardendale Rehabilitation & Nursing Center, L.P. (Gardendale Health & Rehabilitation Center)
• Gateway Community Partners Inc.
• Paul Steven Glass, D.D.S.
• Leslie Z Glover, LPC
• Amber Goldman
• Matthew Goldman, PTA

• Skilled Nursing Facility in Jacksonville, TX
• Providers in Jacksonville, 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 19, 2009; 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.