SOUTHWEST LTC - BONNER LLC (NPI# 1033772413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1033772413 |
Entity Type | Organization |
Organization Name | SOUTHWEST LTC - BONNER LLC |
Practice Address |
810 Bellaire St Jacksonville TX 75766-9045 |
Mailing Address |
5560 Tennyson Pkwy Ste 210 Plano TX 75024-3582 |
Practice Telephone | 9035895300 |
Mailing Telephone | 4699166100 |
Enumeration Date | 2019-04-21 |
Last Update Date | 2019-04-21 |
Authorized Official Name | RONALD PAYNE (PRESIDENT) |
Authorized Official Telephone | 4699166100 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
Other Name | Type Code |
---|---|
Legacy at Jacksonville | Doing Business As Name - Organization |
Street Address |
810 BELLAIRE ST |
City | JACKSONVILLE |
State | TX |
Zip Code | 75766-9045 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689993032 | Jacksonville Scc, LLC | Skilled Nursing Facility | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2010-05-25 |
1417430042 | Christy Michelle Spell | Occupational Therapy Assistant | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2018-09-10 |
1992286710 | Jordan Victoria Smith | Occupational Therapy Assistant | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2018-08-29 |
1699256651 | Dayna Faith Mckey | Physical Therapy Assistant | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2018-08-27 |
1831670017 | Virginia S Lotito | Speech-Language Pathologist | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2018-08-24 |
1477033231 | Matthew Goldman | Physical Therapy Assistant | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2018-08-20 |
1861972937 | Alaina Paige Newman | Clinical Exercise Physiologist | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2018-08-18 |
1093131476 | Nacogdoches County Hospital District | Skilled Nursing Facility | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2014-03-10 |
1588935605 | Clair Johanna Radliff | Physical Therapy Assistant | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2012-01-20 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770062788 | David Rentz | Occupational Therapy Assistant | 838 Brown St., Jacksonville, TX 75766 | 2018-08-09 |
1295233146 | Amanda Dawn Anderson | Licensed Vocational Nurse | Fm 347, Jacksonville, TX 75766 | 2018-01-25 |
1467896241 | Christopher Mark Sirianni | Anesthesiology | 2026 S Jackson St Apt 1213, Jacksonville, TX 75766 | 2013-04-23 |
1164703047 | Aegis Psychological Consulting LLC | Psychologist | 208 E. Rusk St., Jacksonville, TX 75766 | 2011-09-06 |
1952697872 | Melissa Springmeyer | Family Medicine | 2026 South Jacksonville Street, Jacksonville, TX 75766 | 2011-06-20 |
1306031018 | Michael Kay Moore | Occupational Therapist | 4155 Cr 3908, Jacksonville, TX 75766 | 2007-09-06 |
1730398827 | Cherokee County Health Department | Public Health or Welfare | 510 East Commerce, Jacksonville, TX 75766 | 2007-05-22 |
1568689545 | Mary Alice Bone | Preventive Medicine | 510 E. Commerce, Jacksonville, TX 75766 | 2007-04-19 |
1619093176 | Assisted Living Concepts Inc | Assisted Living Facility | 211 Phillip Street, Jacksonville, TX 75766 | 2007-03-22 |
1265560767 | Anderson Cherokee Community Enrichment Services | Counselor | 1011 College Ave, Jacksonville, TX 75766 | 2007-02-28 |
Find all providers in zip 75766 |
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 |
---|---|---|---|---|
1578199303 | First Coast Health Ventures, LLC | Skilled Nursing Facility | 15480 Max Leggett Parkway, Jacksonville, FL 32218 | 2020-03-12 |
1992336895 | Dolphin Pointe Health Care, LLC | Skilled Nursing Facility | 5355 Dolphin Point Rd., Jacksonville, FL 32211 | 2020-01-29 |
1629439260 | West Jax Geriatrics, LLC | Skilled Nursing Facility | 730 College St, Jacksonville, FL 32204-3313 | 2016-03-10 |
1376955377 | Edwin Bato | Skilled Nursing Facility | 3434 Nightscape Cir, Jacksonville, FL 32224-1618 | 2014-05-24 |
1508138678 | Terri Velinda Virgil | Skilled Nursing Facility | 11555 Birch Forest Circle East, Jacksonville, FL 32218 | 2012-02-03 |
1689993032 | Jacksonville Scc, LLC | Skilled Nursing Facility | 810 Bellaire St, Jacksonville, TX 75766-9045 | 2010-05-25 |
1326362005 | Brooks Skilled Nursing Facility, A, Inc. | Skilled Nursing Facility | 6209 Brooks Bartram Dr. Bldg 100, Jacksonville, FL 32258 | 2010-03-24 |
1144476946 | Magnus Opus Technology | Skilled Nursing Facility | 7000 Northlake Dr, Jacksonville, AR 72076-4959 | 2008-08-12 |
1972796175 | Russell Wayne Tolliver | Skilled Nursing Facility | 4083 Sunbeam Rd, Apartment 1409, Jacksonville, FL 32257-8993 | 2007-08-21 |
1750409082 | Patti Sperling Arnp LLC | Skilled Nursing Facility | 402 Myrtlewood Cir, Jacksonville, NC 28546-7412 | 2007-03-26 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 75766 |
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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.