Healthcare Provider Details

I. General information

NPI: 1942209416
Provider Name (Legal Business Name): SENIOR HEALTH TULIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 S AUSTIN
TULIA TX
79088-0000
US

IV. Provider business mailing address

714 S AUSTIN
TULIA TX
79088-0000
US

V. Phone/Fax

Practice location:
  • Phone: 806-995-4810
  • Fax: 806-995-2263
Mailing address:
  • Phone: 806-995-4810
  • Fax: 806-995-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number004559
License Number StateTX

VIII. Authorized Official

Name: MR. LARRY LEE SNOW
Title or Position: REGIONAL CARE MANAGER
Credential: RN
Phone: 940-464-7016