Basic Information
Provider Information | |||||||||
NPI: | 1740287044 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SENIOR HEALTH-FLOYDADA LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FLOYDADA NURSING & REHAB | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2601 SAGEBRUSH DR | ||||||||
Address2: | SUITE 103 | ||||||||
City: | FLOWER MOUND | ||||||||
State: | TX | ||||||||
PostalCode: | 75028 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9724102600 | ||||||||
FaxNumber: | 9724102601 | ||||||||
Practice Location | |||||||||
Address1: | 925 W CROCKETT ST | ||||||||
Address2: |   | ||||||||
City: | FLOYDADA | ||||||||
State: | TX | ||||||||
PostalCode: | 792353609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8069833704 | ||||||||
FaxNumber: | 8069832624 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/30/2005 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SNOW | ||||||||
AuthorizedOfficialFirstName: | LARRY | ||||||||
AuthorizedOfficialMiddleName: | LEE | ||||||||
AuthorizedOfficialTitleorPosition: | REG CASE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9724102600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 115399 | TX | N |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   | 314000000X | 109198 | TX | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.