Basic Information
| Provider Information | |||||||||
| NPI: | 1770649659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HSMTX/REUNION PLAZA, LLC | ||||||||
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| OtherOrganizationName: | REUNION PLAZA SENIOR CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 HOLLISTER ST | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770406137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139347800 | ||||||||
| FaxNumber: | 7138950064 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 RICE RD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757033233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035616060 | ||||||||
| FaxNumber: | 9035348045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 12/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7139347800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 114375 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001017768 | 05 | TX | MEDICAID |