MEDICARE: R. L. TOMS, INC.

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	313M00000X	Nursing Facility/Intermediate Care Facility	116400	TX

General Provider Information

NPI Number	:	1316954456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. L. TOMS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 356
Second Line	:
City	:	BLANCO
State	:	TX
Zip	:	78606-0356
Country	:	US
Telephone Number	:	830-833-4567
Fax Number	:	830-833-2332

Provider Business Practice Location Address
First Line	:	204 HALEY RD.
Second Line	:
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-9998
Country	:	US
Telephone Number	:	830-868-4039
Fax Number	:	830-868-4095

Authorized Official
Title or Position	:	REGIONAL ADMINISTRATOR
Name	:	LYNDI ACHILLES
Credential	:
Telephone Number	:	830-833-4567

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/22/2020

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