Provider Demographics
NPI:1912516329
Name:PATRIOT SKILLED NURSING AND REHABILITATION LLC
Entity type:Organization
Organization Name:PATRIOT SKILLED NURSING AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-441-6629
Mailing Address - Street 1:239 AVE ARTERIAL HOSTOS STE 606
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1347
Mailing Address - Country:US
Mailing Address - Phone:787-232-5005
Mailing Address - Fax:
Practice Address - Street 1:11490 GATEWAY N BLVD.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934
Practice Address - Country:US
Practice Address - Phone:318-812-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility