Healthcare Provider Details

I. General information

NPI: 1598714941
Provider Name (Legal Business Name): MRC PINECREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 TOM TEMPLE DR
LUFKIN TX
75904-5550
US

IV. Provider business mailing address

1302 TOM TEMPLE DR
LUFKIN TX
75904-5550
US

V. Phone/Fax

Practice location:
  • Phone: 936-634-1056
  • Fax: 936-634-1056
Mailing address:
  • Phone: 936-634-1056
  • Fax: 936-634-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. DONALD M STEPHENS
Title or Position: CFO
Credential:
Phone: 281-210-0138