Organization Active NPI

National Nursing & Rehab Adult, LLC

  • Home Health Agency
  • San Antonio, TX
National Provider Identifier
1619216280
Registry record updated Mar 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
015644 Issued in TX
Legal business name
NATIONAL NURSING & REHAB ADULT, LLC
Practice address
85 NE Loop 410
Suite 500
San Antonio, TX 78216-5829
Phone
(210) 822-0475
Fax
(210) 822-0581
NPI assigned
Feb 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2017

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

Authorized official

Name
Mr. Steve D Wallace
Title
Ceo
Phone
(210) 822-0475

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 015644 TX Primary
Nursing Care Agency 251J00000X 015644 TX
In Home Supportive Care Agency 253Z00000X 015644 TX

Addresses

Primary practice location

85 NE Loop 410
Suite 500
San Antonio, TX 78216-5829

Mailing address

85 NE Loop 410
Suite 500
San Antonio, TX 78216-5829
Phone (210) 822-0475

Other identifiers 1

IdentifierTypeStateIssuer
352882001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Sep 14, 2018 Change of OwnershipThis provider was the seller Atex Home HealthcareCCN 679395, TX, NPI 1639650021

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1619216280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 NE LOOP 410",
            "address_2": "SUITE 500",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782165829",
            "telephone_number": "210-822-0475",
            "fax_number": "210-822-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 NE LOOP 410",
            "address_2": "SUITE 500",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782165829",
            "telephone_number": "210-822-0475",
            "fax_number": "210-822-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL NURSING & REHAB ADULT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-822-0475",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "015644",
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "TX",
            "license": "015644",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TX",
            "license": "015644",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "352882001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.