Basic Information
| Provider Information | |||||||||
| NPI: | 1518232974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST TEXAS LTC THE PLAZA AT RICE ROAD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 RICE RD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757033233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035616060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 RICE RD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757033233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035616060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2012 | ||||||||
| LastUpdateDate: | 03/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | POWER | ||||||||
| AuthorizedOfficialFirstName: | CARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9037920838 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.