Provider Demographics
NPI:1013971373
Name:REGENCY NURSING CENTER PARTNERS OF PORT ARTHUR-GOLDEN TRIANGLE, LTD
Entity type:Organization
Organization Name:REGENCY NURSING CENTER PARTNERS OF PORT ARTHUR-GOLDEN TRIANGLE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HEBER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0694
Mailing Address - Street 1:8825 LAMPLIGHTER LN
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7238
Mailing Address - Country:US
Mailing Address - Phone:409-727-1651
Mailing Address - Fax:409-727-2767
Practice Address - Street 1:8825 LAMPLIGHTER LN
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7238
Practice Address - Country:US
Practice Address - Phone:409-727-1651
Practice Address - Fax:409-727-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116137313M00000X
TX4435670001332B00000X
TX675541314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149863601Medicaid
TX001003510Medicaid
TX463002Medicaid
TX198544201Medicaid
TX463002Medicaid
TX149863601Medicaid
TX198544201Medicaid