PHCC-Mystic Park Rehabilitation and Health Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

113652 Issued in TX

Legal business name

PHCC-MYSTIC PARK REHABILITATION AND HEALTH CARE CENTER, LLC

Practice address

8503 Mystic Park
San Antonio, TX 78254-2544

Phone

(210) 256-0906

Fax

(210) 256-0925

NPI assigned

Jun 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. James Arthur Meyers Jr.

Title

President, Cfo

Phone

(210) 545-6320

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mystic Park Rehabilitation and Healthcare Center Doing business as

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992747430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8503 MYSTIC PARK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782542544",
            "telephone_number": "210-256-0906",
            "fax_number": "210-256-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8503 MYSTIC PARK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782542544",
            "telephone_number": "210-256-0906",
            "fax_number": "210-256-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHCC-MYSTIC PARK REHABILITATION AND HEALTH CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEYERS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "PRESIDENT, CFO",
        "authorized_official_telephone_number": "210-545-6320",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "113652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mystic Park Rehabilitation and Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in San Antonio, TX
• Providers in San Antonio, 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.