Basic Information
| Provider Information | |||||||||
| NPI: | 1083021570 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MANOR NURSING AND REHAB CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MANOR HEALTHCARE RESIDENCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 831 TEHUACANA HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | MEXIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547293366 | ||||||||
| FaxNumber: | 2547293475 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 TEHUACANA HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | MEXIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547293366 | ||||||||
| FaxNumber: | 2547293475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2014 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | NEUMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2143963462 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 004746 | 05 | TX | MEDICAID |