Healthcare Provider Details

I. General information

NPI: 1962562868
Provider Name (Legal Business Name): PM MANAGEMENT-WINDCREST NC 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

8800 FOURWINDS DR
SAN ANTONIO TX
78239-1918
US

IV. Provider business mailing address

1703 W FIFTH ST SUITE 700
AUSTIN TX
78703
US

V. Phone/Fax

Practice location:
  • Phone: 210-656-7800
  • Fax: 210-590-0841
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 Number126137
License Number StateTX

VIII. Authorized Official

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