NPIMap

Organization Active NPI

St. Joseph Manor

  • Nursing Facility/Intermediate Care Facility
  • Bryan, TX
National Provider Identifier
1932112554
Registry record updated Apr 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
114596 Issued in TX
Legal business name
ST. JOSEPH MANOR
Practice address
2333 Manor Drive
Bryan, TX 77802-1907
Phone
(979) 821-7330
Fax
(979) 821-7301
NPI assigned
Aug 14, 2006
Last updated
Apr 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2008

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

Authorized official

Name
Mr. Harold Cottrell
Title
Executive Director/Administrator
Phone
(979) 821-7330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 114596 TX Primary

Addresses

Primary practice location

2333 Manor Drive
Bryan, TX 77802-1907

Mailing address

2333 Manor Drive
Bryan, TX 77802-1907
Phone (979) 821-7330

Other identifiers 1

IdentifierTypeStateIssuer
001000504MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Burleson Memorial Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1932112554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 MANOR DRIVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778021907",
            "telephone_number": "979-821-7330",
            "fax_number": "979-821-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 MANOR DRIVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778021907",
            "telephone_number": "979-821-7330",
            "fax_number": "979-821-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "COTTRELL",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/ADMINISTRATOR",
        "authorized_official_telephone_number": "979-821-7330",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "114596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001000504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; 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.