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NPI Code Detail

MEDICARE: EAST TEXAS LTC THE PLAZA AT RICE ROAD LLC

MEDICARE: EAST TEXAS LTC THE PLAZA AT RICE ROAD LLC
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
1314000000XSkilled Nursing FacilityTX

General Provider Information

NPI Number : 1518232974
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS LTC THE PLAZA AT RICE ROAD LLC
Provider Business Mailing Address
First Line : 1401 RICE RD
Second Line :
City : TYLER
State : TX
Zip : 75703-3233
Country : US
Telephone Number : 903-561-6060
Fax Number :
Provider Business Practice Location Address
First Line : 1401 RICE RD
Second Line :
City : TYLER
State : TX
Zip : 75703-3233
Country : US
Telephone Number : 903-561-6060
Fax Number :
Authorized Official
Title or Position : CFO
Name : CARLA POWER
Credential :
Telephone Number : 903-792-0838
Provider Enumeration Date : 03/19/2012
Last Update Date : 03/19/2012

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Directions to “EAST TEXAS LTC THE PLAZA AT RICE ROAD LLC ” Practice Location

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