Provider Demographics
NPI:1154380699
Name:REBECCA ANN INC
Entity type:Organization
Organization Name:REBECCA ANN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-297-0425
Mailing Address - Street 1:914 N BRAZOSPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLUTE
Mailing Address - State:TX
Mailing Address - Zip Code:77531-3720
Mailing Address - Country:US
Mailing Address - Phone:979-265-4794
Mailing Address - Fax:979-265-4898
Practice Address - Street 1:914 N BRAZOSPORT BLVD
Practice Address - Street 2:
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531-3720
Practice Address - Country:US
Practice Address - Phone:979-265-4794
Practice Address - Fax:979-265-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110076314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000466306Medicaid
TX455841Medicare ID - Type Unspecified