Basic Information
| Provider Information | |||||||||
| NPI: | 1376797878 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PM MANAGEMENT - HEWITT NC, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE COURTYARD AT HEWITT NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1703 W. FIFTH ST | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126344900 | ||||||||
| FaxNumber: | 5126344950 | ||||||||
| Practice Location | |||||||||
| Address1: | 8836 MARS DR | ||||||||
| Address2: | |||||||||
| City: | HEWITT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766433195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2544205500 | ||||||||
| FaxNumber: | 2544200005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2008 | ||||||||
| LastUpdateDate: | 08/28/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LITTLE | ||||||||
| AuthorizedOfficialFirstName: | LEW | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5126344900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 126506 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001016516 | 05 | TX | MEDICAID | 103743 | 01 | TX | DADS FACILITY ID | OTHER |