Healthcare Provider Details

I. General information

NPI: 1346892536
Provider Name (Legal Business Name): PARK VALLEY HEALTH CARE CENTER LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17751 PARK VALLEY DR
ROUND ROCK TX
78681-3592
US

IV. Provider business mailing address

2537 GOLDEN BEAR DR
CARROLLTON TX
75006-2377
US

V. Phone/Fax

Practice location:
  • Phone: 214-954-4114
  • Fax:
Mailing address:
  • Phone: 214-954-4114
  • Fax: 214-880-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBIN F UNDERHILL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 214-954-4114