Provider Demographics
NPI:1871584235
Name:KNOPP HEALTHCARE & REHAB CENTER INC
Entity type:Organization
Organization Name:KNOPP HEALTHCARE & REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:I
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-3704
Mailing Address - Street 1:1208 N LLANO ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3514
Mailing Address - Country:US
Mailing Address - Phone:830-997-3704
Mailing Address - Fax:830-997-5245
Practice Address - Street 1:1208 N LLANO ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3514
Practice Address - Country:US
Practice Address - Phone:830-997-3704
Practice Address - Fax:830-990-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115113314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001002989Medicaid
TX4518Medicaid
TX4518Medicaid