Basic Information
| Provider Information | |||||||||
| NPI: | 1548241466 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOWN & COUNTRY MANOR, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780061621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302493085 | ||||||||
| FaxNumber: | 8302498033 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780061621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302493085 | ||||||||
| FaxNumber: | 8302498033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMACK | ||||||||
| AuthorizedOfficialFirstName: | KIMBEL | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8302493085 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 455796 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.