St Johns Episcopal Retirement Corporation

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

110426 Issued in TX

Legal business name

ST JOHNS EPISCOPAL RETIREMENT CORPORATION

Doing business as

Seabury Center

Practice address

2443 W 16TH St
Odessa, TX 79763-2701

Phone

(432) 333-2904

Fax

(432) 333-6454

NPI assigned

Nov 1, 2005

Last updated

Jan 20, 2017By 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

Mrs. Colleen J. Smith

Title

Assistant Administrator

Phone

(432) 333-2904

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Seabury Center Doing business as

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1578554309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2443 W 16TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797632701",
            "telephone_number": "432-333-2904",
            "fax_number": "432-333-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2443 W 16TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797632701",
            "telephone_number": "432-333-2904",
            "fax_number": "432-333-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS EPISCOPAL RETIREMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "432-333-2904",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "110426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000501202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seabury Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nursing Facility/Intermediate Care Facility in Odessa, TX
• Providers in Odessa, TX by specialty
• Nursing Facility/Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.