Healthcare Provider Details

I. General information

NPI: 1982766556
Provider Name (Legal Business Name): PM MANAGEMENT-TRINITY NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
ROUND ROCK TX
78664-4442
US

IV. Provider business mailing address

1703 W 5TH ST SUITE 700
AUSTIN TX
78703-4893
US

V. Phone/Fax

Practice location:
  • Phone: 512-255-2521
  • Fax: 512-255-1491
Mailing address:
  • Phone: 512-634-4900
  • Fax: 512-634-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number127556
License Number StateTX

VIII. Authorized Official

Name: LEW N LITTLE JR.
Title or Position: CEO
Credential:
Phone: 512-634-4900