Basic Information
| Provider Information | |||||||||
| NPI: | 1669949525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT LTC MADISONVILLE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6050 SOUTHWEST BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | BENBROOK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761094004 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 BACON ST | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778642575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9363489097 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2018 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | SLIMMER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8176814811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.