Healthcare Provider Details

I. General information

NPI: 1952565624
Provider Name (Legal Business Name): MARSHALL SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 S WASHINGTON AVE
MARSHALL TX
75670-5333
US

IV. Provider business mailing address

1007 S WASHINGTON AVE
MARSHALL TX
75670-5333
US

V. Phone/Fax

Practice location:
  • Phone: 903-935-7971
  • Fax: 903-935-1908
Mailing address:
  • Phone: 903-935-7971
  • Fax: 903-935-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120459
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number120459
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number120459
License Number StateTX

VIII. Authorized Official

Name: MS. LINDA K. BENSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 903-935-7971