Basic Information
| Provider Information | |||||||||
| NPI: | 1417598368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CC SNF TX MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 CENTRAL AVE UNIT 101 | ||||||||
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| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115162329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123229223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3050 SUNNYBROOK RD | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784151748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618539981 | ||||||||
| FaxNumber: | 3618531907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2122993223 | ||||||||
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| 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 |
No ID Information.