Healthcare Provider Details

I. General information

NPI: 1922270859
Provider Name (Legal Business Name): FAMILY OF PARK PLAZA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 STATE PARK ROAD
WHITNEY TX
76692-4313
US

IV. Provider business mailing address

PO BOX 2105
WHITNEY TX
76692-5105
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-2239
  • Fax:
Mailing address:
  • Phone: 254-694-3555
  • Fax: 254-694-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number004587
License Number StateTX

VIII. Authorized Official

Name: MRS. PATRICIA DIANE WARD
Title or Position: PRESIDENT/MANAGING MEMBER
Credential:
Phone: 254-694-3555