1962484881 NPI number — PHPM MISSION CARE CENTERS - NEW COVENANT, LP

Table of content: (NPI 1962484881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962484881 NPI number — PHPM MISSION CARE CENTERS - NEW COVENANT, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHPM MISSION CARE CENTERS - NEW COVENANT, LP
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:
HACIENDA OAKS NURSING AND REHABILITATION
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:
1962484881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420 W PLANO PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-4823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-931-3800
Provider Business Mailing Address Fax Number:
972-767-6222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1637 N KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEGUIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78155-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-379-3784
Provider Business Practice Location Address Fax Number:
830-303-7153
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
LATTURE
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
972-931-3800

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  113234 , 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: 001012953 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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