Basic Information
| Provider Information | |||||||||
| NPI: | 1902808058 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR CARE MANAGEMENT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HONEY GROVE NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1413 EAST I 30 | ||||||||
| Address2: | STE 7 | ||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750434598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723039000 | ||||||||
| FaxNumber: | 9723039992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 MAIN ST E | ||||||||
| Address2: | |||||||||
| City: | HONEY GROVE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754461268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723039000 | ||||||||
| FaxNumber: | 9723039992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 11/13/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP CFO | ||||||||
| AuthorizedOfficialTelephone: | 9723039000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 004858 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | HH2602 | 01 | TX | BLUE CROSS/BLUE SHIELD | OTHER |