SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC (NPI# 1285697763) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285697763 |
| Entity Type | Organization |
| Organization Name | SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC |
| Other Organization Name | SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER |
| Practice Address |
1401 W Main St Edna TX 77957-2454 |
| Practice Telephone | 3617827614 |
| Practice Fax Number | 3617825612 |
| Mailing Telephone | 3617827614 |
| Mailing Fax Number | 3617825612 |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. HEBER S LACERDA (PRESIDENT/CEO) |
| Authorized Official Telephone | 3615760694 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | 115308 | TX | Nursing & Custodial Care Facilities |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 1005880001 | TX | Suppliers |
| Y | 314000000X | Skilled Nursing Facility | 675159 | TX | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS BLUELINK | HH045S | 01 |
| TX | 530201 | 05 |
| Other Name | Type Code |
|---|---|
| SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER | Doing Business As Name - Organization |
| Street Address |
1401 W MAIN ST |
| City | EDNA |
| State | TX |
| Zip Code | 77957-2454 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386124865 | Tracy Yenawine Oldag | Physical Therapy Assistant | 1401 W Main St, Edna, TX 77957-2454 | 2018-08-15 |
| 1407336878 | Grace Ann Green | Physical Therapy Assistant | 1401 W Main St, Edna, TX 77957-2454 | 2018-08-15 |
| 1194205690 | Holly Keen | Physical Therapy Assistant | 1401 W Main St, Edna, TX 77957-2454 | 2018-08-15 |
| 1033699699 | Kimberly Alvarado | Occupational Therapy Assistant | 1401 W Main St, Edna, TX 77957 | 2018-08-14 |
| 1801217997 | Citizens Medical Center County of Victoria | Skilled Nursing Facility | 1401 W Main St, Edna, TX 77957-2454 | 2013-12-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043399330 | Mchenry Lee | Dentist | 118 N Wells St, Edna, TX 77957 | 2006-11-06 |
| 1740377522 | Travis R Phillips | Dentist | 502 North Wells, Edna, TX 77957 | 2006-10-05 |
| 1952417123 | Dawn Rachelle Jalufka | Optometrist | 201 N Wells, Enda, TX 77957 | 2006-08-21 |
| 1255468948 | Jackson County Special Services Coop | Local Education Agency (LEA) | 606 Gilbert Street, Edna, TX 77957-0919 | 2007-02-28 |
| 1760455158 | Fmsc Edna Operating Company Lp | Skilled Nursing Facility | 1204 N Wells St, Edna, TX 77957-2149 | 2006-02-08 |
| 1063558526 | Care Inn of Edna LLC | Skilled Nursing Facility | 1204 N Wells St, Edna, TX 77957-2149 | 2007-01-30 |
| 1245760784 | Emilie Faucheu | Dentist | 1006 N Wells St, Edna, TX 77957-2153 | 2017-06-18 |
| 1801813076 | Wal-mart Stores Texas LLC | Durable Medical Equipment & Medical Supplies | 1002 N Wells St, Edna, TX 77957-2153 | 2006-07-16 |
| 1558317172 | Total Renal Care Texas Limited Partnership | Clinic/Center | 1008 N Wells St, Edna, TX 77957-2153 | 2006-05-25 |
| 1053562850 | Hayden Chiropractic, Pllc | Chiropractor | 522 W Main St, Edna, TX 77957-2569 | 2008-10-10 |
| Find all providers in zip 77957 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (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. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760455158 | Fmsc Edna Operating Company Lp | Skilled Nursing Facility | 1204 N Wells St, Edna, TX 77957-2149 | 2006-02-08 |
| 1801217997 | Citizens Medical Center County of Victoria | Skilled Nursing Facility | 1401 W Main St, Edna, TX 77957-2454 | 2013-12-17 |
| 1063558526 | Care Inn of Edna LLC | Skilled Nursing Facility | 1204 N Wells St, Edna, TX 77957-2149 | 2007-01-30 |
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|---|---|---|---|---|
| 1285233171 | Center At Zaragoza, LLC | Skilled Nursing Facility | 12660 Pebble Hills Blvd., El Paso, TX 79936 | 2020-10-21 |
| 1609473362 | Touchstone Strategies - Penitas, LLC | Skilled Nursing Facility | 414 Liberty Blvd., Penitas, TX 78576 | 2020-10-06 |
| 1649884313 | Springtown Ventures Lp | Skilled Nursing Facility | 201 Williams Ward Rd., Springtown, TX 76082 | 2020-09-01 |
| 1821601691 | Altamira Healthcare LLC | Skilled Nursing Facility | 200 Carla St, Zapata, TX 78076-3114 | 2020-08-31 |
| 1538770839 | Go Operations 3 LLC | Skilled Nursing Facility | 4366 Lockhill Selma, Shavano, TX 78249 | 2020-08-11 |
| 1912516329 | Patriot Skilled Nursing and Rehabilitation LLC | Skilled Nursing Facility | 11490 Gateway N Blvd., El Paso, TX 79934 | 2020-07-31 |
| 1972112464 | The Brixton At Horseshoe Bay | Skilled Nursing Facility | 15101 West Fm 2147, Horseshoe Bay, TX 78657 | 2020-07-30 |
| 1558984278 | Slp Johnson City LLC | Skilled Nursing Facility | 206 Haley Rd, Johnson City, TX 78636-4617 | 2020-05-28 |
| 1073136149 | Continuum Rehab Group | Skilled Nursing Facility | 3326 Burgoyne St # 1432, Dallas, TX 75233-1304 | 2020-05-24 |
| 1750904264 | Frank Villanueva | Skilled Nursing Facility | 711 W Broadway St, Denver City, TX 79323-3000 | 2020-05-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.