MEDICARE: PHPM MISSION CARE CENTERS - NEW COVENANT LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	113790	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164404075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHPM MISSION CARE CENTERS - NEW COVENANT LP

Provider Business Mailing Address
First Line	:	5420 W PLANO PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4823
Country	:	US
Telephone Number	:	972-931-3800
Fax Number	:	972-767-6222

Provider Business Practice Location Address
First Line	:	106 DEL NORTE DR
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-2504
Country	:	US
Telephone Number	:	979-543-6762
Fax Number	:	979-543-9626

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MRS. JAMIE LATTURE COLLIER
Credential	:
Telephone Number	:	972-731-3800

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	11/13/2014

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