1962562868 NPI number — PM MANAGEMENT-WINDCREST NC LLC

Table of content: (NPI 1962562868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962562868 NPI number — PM MANAGEMENT-WINDCREST NC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PM MANAGEMENT-WINDCREST NC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRISUN CARE CENTER-WINDCREST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962562868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1703 W FIFTH ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-634-4900
Provider Business Mailing Address Fax Number:
512-634-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 FOURWINDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78239-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-656-7800
Provider Business Practice Location Address Fax Number:
210-590-0841
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
LEW
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
512-634-4900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  126137 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005109 . This is a "FACILITY ID NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001012311 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com