Healthcare Provider Details

I. General information

NPI: 1629163860
Provider Name (Legal Business Name): PECAN GROVE HEALTH CARE LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 GOLFVIEW DR
RICHMOND TX
77469-5120
US

IV. Provider business mailing address

1106 GOLFVIEW DR P.O. BOX 1189
RICHMOND TX
77469-5120
US

V. Phone/Fax

Practice location:
  • Phone: 281-344-9191
  • Fax: 830-597-5361
Mailing address:
  • Phone: 281-344-9191
  • Fax: 830-597-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5273
License Number StateTX

VIII. Authorized Official

Name: MRS. TAMARA D SCOTCH
Title or Position: PARTNER
Credential:
Phone: 830-597-5445