Healthcare Provider Details

I. General information

NPI: 1942200852
Provider Name (Legal Business Name): MRC CORNERSTONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 MOORES LN
TEXARKANA TX
75503-5102
US

IV. Provider business mailing address

1440 LAKE FRONT CIRCLE SUITE 140
THE WOODLANDS TX
77380
US

V. Phone/Fax

Practice location:
  • Phone: 903-831-2968
  • Fax: 903-832-5553
Mailing address:
  • Phone: 281-210-0138
  • Fax: 281-292-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number113743
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113743
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DON STEPHENS
Title or Position: TREASURER/CFO
Credential:
Phone: 281-210-0138