Provider Demographics
NPI:1699736421
Name:NEXION HEALTH AT BOGATA, INC.
Entity type:Organization
Organization Name:NEXION HEALTH AT BOGATA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-552-4800
Mailing Address - Street 1:6937 WARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7454
Mailing Address - Country:US
Mailing Address - Phone:410-552-4800
Mailing Address - Fax:
Practice Address - Street 1:2407 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-3327
Practice Address - Country:US
Practice Address - Phone:903-427-3821
Practice Address - Fax:903-427-5111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXION HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114691314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003601Medicaid
TX1593543Medicaid
TX004267OtherSTATE VENDOR NUMBER
TX001003601Medicaid