Healthcare Provider Details

I. General information

NPI: 1831199751
Provider Name (Legal Business Name): MRC TOWNCREEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 VETERANS MEMORIAL PARKWAY
HUNTSVILLE TX
77340
US

IV. Provider business mailing address

1433 VETERANS MEMORIAL PARKWAY
HUNTSVILLE TX
77340
US

V. Phone/Fax

Practice location:
  • Phone: 936-295-0216
  • Fax: 936-291-2907
Mailing address:
  • Phone: 936-295-0216
  • Fax: 936-291-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number137327
License Number StateTX

VIII. Authorized Official

Name: MS. DEVON COX
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 28121001230