Basic Information
| Provider Information | |||||||||
| NPI: | 1437159191 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR HEALTH TEXOMA LLC | ||||||||
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| OtherOrganizationName: | TEXOMA SPECIALTY CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 SAGEBRUSH DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724102600 | ||||||||
| FaxNumber: | 9724102601 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034657442 | ||||||||
| FaxNumber: | 9034652558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SNOW | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CASE MGR | ||||||||
| AuthorizedOfficialTelephone: | 9724102600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 119143 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.