Healthcare Provider Details

I. General information

NPI: 1912974866
Provider Name (Legal Business Name): MANOR PARK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 N LOOP 250 W
MIDLAND TX
79707-6011
US

IV. Provider business mailing address

2208 N LOOP 250 W
MIDLAND TX
79707-6011
US

V. Phone/Fax

Practice location:
  • Phone: 432-689-9898
  • Fax: 432-694-2551
Mailing address:
  • Phone: 432-689-9898
  • Fax: 432-694-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number116128
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116128
License Number StateTX

VIII. Authorized Official

Name: MR. STEPHEN NELSON
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 432-689-9898