Century-Ebony Lake-Geac,LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

112530 Issued in TX

Legal business name

CENTURY-EBONY LAKE-GEAC,LLC

Doing business as

Ebony Lake Health Care Center

Practice address

1001 Central Blvd
Brownsville, TX 78520-7533

Phone

(956) 541-0917

Fax

(956) 541-2860

NPI assigned

Sep 29, 2005

Last updated

Aug 22, 2020By 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

Ms. Diane M Ryan, RN,MS

Title

Owner's Representative

Phone

(952) 837-0818

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ebony Lake Health Care Center Doing business as

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740277391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CENTRAL BLVD",
            "city": "BROWNSVILLE",
            "state": "TX",
            "postal_code": "785207533",
            "telephone_number": "956-541-0917",
            "fax_number": "956-541-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CENTRAL BLVD",
            "city": "BROWNSVILLE",
            "state": "TX",
            "postal_code": "785207533",
            "telephone_number": "956-541-0917",
            "fax_number": "956-541-2860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTURY-EBONY LAKE-GEAC,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER'S REPRESENTATIVE",
        "authorized_official_telephone_number": "952-837-0818",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN,MS"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "112530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005259",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebony Lake Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Brownsville, TX
• Providers in Brownsville, 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 Aug 22, 2020; 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.