Healthcare Provider Details

I. General information

NPI: 1609806579
Provider Name (Legal Business Name): LEE BIVINS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 KILLGORE DR
AMARILLO TX
79106-3700
US

IV. Provider business mailing address

PO BOX 1727
AMARILLO TX
79105-1727
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-2200
  • Fax: 806-354-8537
Mailing address:
  • Phone: 806-379-9400
  • Fax: 806-379-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number112385
License Number StateTX

VIII. Authorized Official

Name: MR. PAUL J SNEED
Title or Position: CFO
Credential:
Phone: 806-379-9400