Healthcare Provider Details

I. General information

NPI: 1528067121
Provider Name (Legal Business Name): PANOLA 501 PARTNERS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 COTTAGE RD
CARTHAGE TX
75633-1467
US

IV. Provider business mailing address

501 COTTAGE RD
CARTHAGE TX
75633-1467
US

V. Phone/Fax

Practice location:
  • Phone: 903-693-7141
  • Fax: 903-693-4187
Mailing address:
  • Phone: 903-693-7141
  • Fax: 903-693-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number112543
License Number StateTX

VIII. Authorized Official

Name: MR. ALEX PALEY
Title or Position: COO
Credential:
Phone: 914-390-4363