Provider Demographics
NPI:1053743856
Name:TRANSITIONAL LEARNING CENTER AT GALVESTON
Entity type:Organization
Organization Name:TRANSITIONAL LEARNING CENTER AT GALVESTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-797-1468
Mailing Address - Street 1:1528 POSTOFFICE STREET
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-4833
Mailing Address - Country:US
Mailing Address - Phone:409-797-1468
Mailing Address - Fax:
Practice Address - Street 1:6444 CENTRAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2058
Practice Address - Country:US
Practice Address - Phone:409-741-3266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0401X, 3104A0625X
TX134987310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150157OtherTEXAS HEALTH & HUMAN SERVICES ASSISTED LIVING FACILITY LICENSE
TX148770OtherTEXAS HEALTH & HUMAN SERVICES ASSISTED LIVING FACILITY LICENSE