Salem Housing Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

116446 Issued in TX

Legal business name

SALEM HOUSING CORPORATION

Practice address

315 W Gibson St
Jasper, TX 75951-4903

Phone

(409) 384-5768

Fax

(409) 383-1940

NPI assigned

Jul 9, 2006

Organization subpart

No

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

Authorized official

Name

Douglas K. Mittleider

Title

President of MGMT Co

Phone

(770) 619-0866

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Timberlake Health and Rehabilitation Doing business as

Locations

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1962435149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5895 WINDWARD PKWY",
            "address_2": "SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300055203",
            "telephone_number": "770-619-0866",
            "fax_number": "770-870-2892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W GIBSON ST",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "759514903",
            "telephone_number": "409-384-5768",
            "fax_number": "409-383-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM HOUSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "MITTLEIDER",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT OF MGMT CO",
        "authorized_official_telephone_number": "770-619-0866"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "116446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001013913",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timberlake Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Andrew Rotsch
• Tamara Nicole Rotsch, RN
• Kathleen M Russell, LMSW
• Lisa Marie Russell, RPH
• S&R Pharmaceuticals
• Donald Samuel, MD
• Blake Katherine Sayers, MS. CCC-SLP
• Lauren Jean Schaeffer, FNP-C
• Rebecca M Schneider, MD
• Serenitybridge Counseling and Training Center

• Skilled Nursing Facility in Jasper, TX
• Providers in Jasper, 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 May 20, 2010; 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.