Provider Demographics
NPI:1104098458
Name:LAMPSTAND HEALTH & REHAB OF BRYAN, LLC
Entity type:Organization
Organization Name:LAMPSTAND HEALTH & REHAB OF BRYAN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:2723 SUMMER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2858
Mailing Address - Country:US
Mailing Address - Phone:901-937-7994
Mailing Address - Fax:901-937-1516
Practice Address - Street 1:2001 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1954
Practice Address - Country:US
Practice Address - Phone:979-822-6611
Practice Address - Fax:979-822-6699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESCENDING DOVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016041Medicaid
TX676019Medicare Oscar/Certification