Basic Information
Provider Information | |||||||||
NPI: | 1255654133 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SEARS TYLER METHODIST RETIREMENT CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LONGLEAF MEADOWS HEALTHCARE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 VILLAGE DR | ||||||||
Address2: | SUITE 400 | ||||||||
City: | ABILENE | ||||||||
State: | TX | ||||||||
PostalCode: | 796068231 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3286915519 | ||||||||
FaxNumber: | 3256984582 | ||||||||
Practice Location | |||||||||
Address1: | 16044 COUNTY ROAD 165 | ||||||||
Address2: |   | ||||||||
City: | TYLER | ||||||||
State: | TX | ||||||||
PostalCode: | 757037302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9035265599 | ||||||||
FaxNumber: | 9035263717 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/08/2010 | ||||||||
LastUpdateDate: | 02/22/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MERE | ||||||||
AuthorizedOfficialFirstName: | THERESA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
AuthorizedOfficialTelephone: | 3256915519 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   |   | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.