Provider Demographics
NPI:1679955843
Name:TIMBERIDGE NURSING AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:TIMBERIDGE NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-590-0007
Mailing Address - Street 1:315 W GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4903
Mailing Address - Country:US
Mailing Address - Phone:409-384-5768
Mailing Address - Fax:409-381-8774
Practice Address - Street 1:315 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4903
Practice Address - Country:US
Practice Address - Phone:409-384-5768
Practice Address - Fax:409-381-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675709Medicare Oscar/Certification