Healthcare Provider Details

I. General information

NPI: 1164404075
Provider Name (Legal Business Name): PHPM MISSION CARE CENTERS - NEW COVENANT LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DEL NORTE DR
EL CAMPO TX
77437-2504
US

IV. Provider business mailing address

5420 W PLANO PKWY
PLANO TX
75093-4823
US

V. Phone/Fax

Practice location:
  • Phone: 979-543-6762
  • Fax: 979-543-9626
Mailing address:
  • Phone: 972-931-3800
  • Fax: 972-767-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113790
License Number StateTX

VIII. Authorized Official

Name: MRS. JAMIE LATTURE COLLIER
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 972-731-3800