Healthcare Provider Details

I. General information

NPI: 1780671362
Provider Name (Legal Business Name): MASON CONVALESCENT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E COLLEGE STREET
MASON TX
76856-0107
US

IV. Provider business mailing address

110 E COLLEGE STREET PO BOX 1668
MASON TX
76856-0107
US

V. Phone/Fax

Practice location:
  • Phone: 325-347-6383
  • Fax: 325-347-6142
Mailing address:
  • Phone: 325-347-6383
  • Fax: 325-347-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number113248
License Number StateTX

VIII. Authorized Official

Name: MRS. JANICE PITA
Title or Position: INSURANCE/MEDICARE
Credential:
Phone: 580-622-6300