Basic Information
| Provider Information | |||||||||
| NPI: | 1598036717 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOATRIGHT NURSING CENTERS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MISSION MANOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 E COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758401603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033891009 | ||||||||
| FaxNumber: | 9033891090 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 YATES ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754573233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035374424 | ||||||||
| FaxNumber: | 9035373427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2012 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUMPASS | ||||||||
| AuthorizedOfficialFirstName: | DUDLEY | ||||||||
| AuthorizedOfficialMiddleName: | MAX | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9033891009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.