Healthcare Provider Details

I. General information

NPI: 1952301657
Provider Name (Legal Business Name): BALMORAL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W BRITISH FLYING SCHOOL BLVD
TERRELL TX
75160-0043
US

IV. Provider business mailing address

250 W BRITISH FLYING SCHOOL BLVD
TERRELL TX
75160-0043
US

V. Phone/Fax

Practice location:
  • Phone: 972-551-0122
  • Fax: 972-551-3307
Mailing address:
  • Phone: 972-551-0122
  • Fax: 972-551-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number105936
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number105936
License Number StateTX

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 816-444-0900