Healthcare Provider Details

I. General information

NPI: 1932506474
Provider Name (Legal Business Name): QUITMAN NURSING AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2014
Last Update Date: 11/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 E GOODE ST
QUITMAN TX
75783-1641
US

IV. Provider business mailing address

111 CLIFTON AVE STE 12
LAKEWOOD NJ
08701-3342
US

V. Phone/Fax

Practice location:
  • Phone: 903-763-2284
  • Fax:
Mailing address:
  • Phone: 214-396-3462
  • Fax: 214-396-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number004108
License Number StateTX

VIII. Authorized Official

Name: JOE NEUMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 214-396-3462