Healthcare Provider Details

I. General information

NPI: 1770649659
Provider Name (Legal Business Name): HSMTX/REUNION PLAZA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 RICE RD
TYLER TX
75703-3233
US

IV. Provider business mailing address

5300 HOLLISTER ST SUITE 550
HOUSTON TX
77040-6137
US

V. Phone/Fax

Practice location:
  • Phone: 903-561-6060
  • Fax: 903-534-8045
Mailing address:
  • Phone: 713-934-7800
  • Fax: 713-895-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114375
License Number StateTX

VIII. Authorized Official

Name: CHARLES A DAVIS
Title or Position: VP FINANCE
Credential:
Phone: 713-934-7800