Healthcare Provider Details

I. General information

NPI: 1659514867
Provider Name (Legal Business Name): S.U.R. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 OLD ANSON RD
ABILENE TX
79603-2210
US

IV. Provider business mailing address

9450 FM 2210 E
POOLVILLE TX
76487-5028
US

V. Phone/Fax

Practice location:
  • Phone: 325-673-5101
  • Fax: 325-673-0568
Mailing address:
  • Phone: 940-374-3804
  • Fax: 940-374-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number127476
License Number StateTX

VIII. Authorized Official

Name: MONTE RANDALL
Title or Position: VP OF OPERATIONS
Credential:
Phone: 940-374-3804