Basic Information
| Provider Information | |||||||||
| NPI: | 1881086486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PM MANAGEMENT - ROUND ROCK AL LLC | ||||||||
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| OtherOrganizationName: | WYOMING SPRINGS ASSISTED LIVING AND MEMORY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 N PEARL ST | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752012822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142527600 | ||||||||
| FaxNumber: | 2142527599 | ||||||||
| Practice Location | |||||||||
| Address1: | 7230 WYOMING SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786814319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127657733 | ||||||||
| FaxNumber: | 5122180073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2015 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROGERS | ||||||||
| AuthorizedOfficialFirstName: | WENDI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF RISK MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5123407829 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.