Provider Demographics
NPI:1104085422
Name:RJ MERIDIAN CARE OF HEBBRONVILLE, LTD
Entity type:Organization
Organization Name:RJ MERIDIAN CARE OF HEBBRONVILLE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-827-5818
Mailing Address - Street 1:25009 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1975
Mailing Address - Country:US
Mailing Address - Phone:281-465-0636
Mailing Address - Fax:281-465-0748
Practice Address - Street 1:606 W GRUY ST
Practice Address - Street 2:
Practice Address - City:HEBBRONVILLE
Practice Address - State:TX
Practice Address - Zip Code:78361-3118
Practice Address - Country:US
Practice Address - Phone:361-527-4411
Practice Address - Fax:361-527-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5389Medicaid
TX675796Medicare Oscar/Certification