Healthcare Provider Details

I. General information

NPI: 1104986041
Provider Name (Legal Business Name): PM MANAGEMENT-SAN ANGELO NC II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 SUMMER CREST DR
SAN ANGELO TX
76901-9782
US

IV. Provider business mailing address

1703 W. FIFTH ST SUITE 700
AUSTIN TX
78703
US

V. Phone/Fax

Practice location:
  • Phone: 325-947-8776
  • Fax: 325-224-2666
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 Number123446
License Number StateTX

VIII. Authorized Official

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