Basic Information
Provider Information | |||||||||
NPI: | 1669459491 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CENTRAL TEXAS EQUITIES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MEMPHIS CONVALESCENT CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1415 N 18TH ST | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TX | ||||||||
PostalCode: | 792452009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8062593566 | ||||||||
FaxNumber: | 8062595098 | ||||||||
Practice Location | |||||||||
Address1: | 1415 N 18TH ST | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TX | ||||||||
PostalCode: | 792452009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8062593566 | ||||||||
FaxNumber: | 8062595098 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/22/2005 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DICKSON | ||||||||
AuthorizedOfficialFirstName: | ANGELIN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | REGIONAL ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 8062593566 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LNFA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 115672 | TX | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.