| NPI | 1023406857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BELINDA GAIL ELLIS Registered Nurse 737-210-9558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TX 716452) |
| Additional Taxonomies | 251J00000X Nursing Care (Licence: TX 716452) |
| 302R00000X Health Maintenance Organization (Licence: TX 716452) | |
| 305S00000X Point of Service (Licence: TX 716452) | |
| Enumeration Date | 2015-01-01 |
| Last Update Date | 2015-01-01 |