VILLA DEL MAR AT MAINLAND CENTER (THE RIO AT MAINLAND CENTER) - NPI NUMBER 1508288325

Summary

Provider Name: VILLA DEL MAR AT MAINLAND CENTER (THE RIO AT MAINLAND CENTER)

NPI Number: 1508288325

Clasification: Skilled Nursing Facility (314000000X)

Address:
1011 MAINLAND CENTER DRIVE
TEXAS CITY, TX
ZIP 77591

Phone Number: (713) 358-0700



Detailed Information

VILLA DEL MAR AT MAINLAND CENTER is a skilled nursing facility in Texas City, TX. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. The assigned NPI number for this provider is 1508288325 and is registered as an organization entity type.
The provider Is Doing Business As The Rio At Mainland Center.

The provider's business address is:

1011 MAINLAND CENTER DRIVE
TEXAS CITY, TX
ZIP 77591-666
Phone: (713) 358-0700
Fax: (713) 358-0701

The provider's authorized official is Jerry Williamson .
The authorized official title is Officer and has the following contact phone number (469) 767-7238.

The enumeration date for this NPI number is 1/14/2014 and was last updated on 9/19/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 314000000X Skilled Nursing Facility TX Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 001025697 MEDICAID TX
2 676360 MEDICARE OSCAR/CERTIFICATION TX

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1508288325 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name VILLA DEL MAR AT MAINLAND CENTER The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name THE RIO AT MAINLAND CENTER Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 1011 MAINLAND CENTER DRIVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name TEXAS CITY The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name TX The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 775912666 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 7133580700 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 7133580701 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 1/14/2014 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 9/19/2014 The date that a record was last updated or changed.
16 Authorized Official Last Name WILLIAMSON The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name JERRY The first name of the authorized official.
18 Authorized Official Title or Position OFFICER The title or position of the authorized official.
19 Authorized Official Telephone Number 4697677238 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 314000000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number State Code 1 TX The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 001025697 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 TX
26 Other Provider Identifier 2 676360 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 2 06 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 2 TX
29 Is Organization Subpart N

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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