Healthcare Provider Details

I. General information

NPI: 1154688661
Provider Name (Legal Business Name): PM MANAGEMENT - SAN ANTONIO NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 LAKESIDE PKWY
SAN ANTONIO TX
78245-3245
US

IV. Provider business mailing address

600 N PEARL ST STE 1050
DALLAS TX
75201-7495
US

V. Phone/Fax

Practice location:
  • Phone: 512-634-4900
  • Fax:
Mailing address:
  • Phone: 214-252-7600
  • Fax: 214-252-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number135408
License Number StateTX

VIII. Authorized Official

Name: MICHAEL BEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 214-252-7600