Organization
MYSTIC PARK SCC LLC
Active
Other names
Mystic Park Nursing & Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
8503 MYSTIC PARK, SAN ANTONIO, TX 78254-2544
(210) 256-0906
(210) 256-0925
Mailing address
600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001026539
—
TX
01
—
5447 101669
VENDORID/FACILITY ID
TX
Enumeration date
12/29/2014
Last updated
03/03/2020
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