Provider Demographics
NPI:1841297850
Name:MATAGORDA NURSING AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:MATAGORDA NURSING AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:361-576-9454
Mailing Address - Street 1:PO BOX 7230
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-7230
Mailing Address - Country:US
Mailing Address - Phone:361-576-9454
Mailing Address - Fax:361-576-2994
Practice Address - Street 1:4521 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-8011
Practice Address - Country:US
Practice Address - Phone:979-245-7369
Practice Address - Fax:979-245-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109311314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003303Medicaid
TX150060501Medicaid
TX5336Medicaid
TX5336Medicaid
TX4367850001Medicare NSC
TX675899Medicare Oscar/Certification
TX150200701Medicare ID - Type UnspecifiedMEDICARE PART B #