Healthcare Provider Details

I. General information

NPI: 1801979455
Provider Name (Legal Business Name): MORNINGSTAR OPERATING #4, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 LINCOLN PARK DR
CLEBURNE TX
76033-7015
US

IV. Provider business mailing address

318 BRIAR ROCK ROAD
THE WOODLANDS TX
77380
US

V. Phone/Fax

Practice location:
  • Phone: 817-558-4787
  • Fax: 817-556-3445
Mailing address:
  • Phone: 281-363-1005
  • Fax: 281-292-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114958
License Number StateTX

VIII. Authorized Official

Name: MR. JOHN WILCOX
Title or Position: OWNER
Credential:
Phone: 281-363-1005