Basic Information
Provider Information | |||||||||
NPI: | 1013954973 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KNICHOLS & BNICHOLS HEALTHCARE INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SENIOR CITIZENS NURSING HOME | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 118 E LIVE OAK ST | ||||||||
Address2: |   | ||||||||
City: | DUBLIN | ||||||||
State: | TX | ||||||||
PostalCode: | 764461941 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2544452517 | ||||||||
FaxNumber: | 2544453960 | ||||||||
Practice Location | |||||||||
Address1: | 506 VAN NESS ST | ||||||||
Address2: |   | ||||||||
City: | WINTERS | ||||||||
State: | TX | ||||||||
PostalCode: | 795674724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2547544566 | ||||||||
FaxNumber: | 2547544634 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2006 | ||||||||
LastUpdateDate: | 09/28/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NICHOLS | ||||||||
AuthorizedOfficialFirstName: | BOBBIE | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | V. PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2544452517 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 114057 | TX | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.