Basic Information
| Provider Information | |||||||||
| NPI: | 1942209416 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR HEALTH TULIA LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TULIA NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 S AUSTIN | ||||||||
| Address2: | |||||||||
| City: | TULIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790880000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069954810 | ||||||||
| FaxNumber: | 8069952263 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 S AUSTIN | ||||||||
| Address2: | |||||||||
| City: | TULIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790880000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069954810 | ||||||||
| FaxNumber: | 8069952263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SNOW | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CARE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9404647016 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 004559 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4559 | 05 | TX | MEDICAID |