1245297365 NPI number — NEXION HEALTH AT GILMER INC

Table of content: (NPI 1245297365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245297365 NPI number — NEXION HEALTH AT GILMER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXION HEALTH AT GILMER INC
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:
UPSHUR MANOR NURSING HOME
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:
1245297365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6937 WARFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21784-7454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-552-4800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 HIGHWAY 155 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILMER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-797-2143
Provider Business Practice Location Address Fax Number:
903-797-2725
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIRLEY
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-552-4800

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  005293 , 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: 001003602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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