Basic Information
| Provider Information | |||||||||
| NPI: | 1245297365 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEXION HEALTH AT GILMER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UPSHUR MANOR NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6937 WARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217847454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105524800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 623 HIGHWAY 155 NORTH | ||||||||
| Address2: | |||||||||
| City: | GILMER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037972143 | ||||||||
| FaxNumber: | 9037972725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KIRLEY | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4105524800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEXION HEALTH INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 005293 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001003602 | 05 | TX | MEDICAID |