# BANDERA SCC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bandera Nursing & Rehab Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992103436
- **Authorized official:** MICAHEL BEAL (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (214) 252-7600

## Contact information

- **Practice address:** 222 FM 1077, BANDERA, TX 78003-4765
- **Practice address phone:** (803) 796-4077
- **Practice address fax:** (803) 796-3539
- **Mailing address:** 600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
- **Mailing address phone:** (214) 252-7600
- **Mailing address fax:** (214) 252-7704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |

## Other

- **Enumeration date:** 12/16/2014
- **Last updated:** 03/04/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001026809 | — | TX |
| 01 | — | 5557 103936 | VENDORID/FACILITY ID | TX |