Basic Information
| Provider Information | |||||||||
| NPI: | 1518003540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MESA SPRINGS RETIREMENT VILLAGE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7171 BUFFALO GAP RD | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796065450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256702182 | ||||||||
| FaxNumber: | 3256926228 | ||||||||
| Practice Location | |||||||||
| Address1: | 7171 BUFFALO GAP RD | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796065450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256702182 | ||||||||
| FaxNumber: | 3256926228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | KIMMEL | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3256702182 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 117944 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 000537801 | 05 | TX | MEDICAID | 000673800 | 05 | TX | MEDICAID |