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General NPI Number Information
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NPI Number | 1053317107
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Entity Type | Organization
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Legal Business Name | PSG TEMPLE LLC
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 100 GREEN AVE
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City | TEMPLE
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State | OK
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Zip | 73568
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Country | US
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Telephone | 580-342-6228
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Fax | 580-342-5015
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Provider Business Mailing Address
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Address Line | 100 GREEN AVENUE
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City | TEMPLE
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State | OK
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Zip | 73568
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Country | US
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Telephone | 580-342-6228
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Fax | 580-342-5015
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LUCRETIA LEE PARKEY
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Credential |
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Telephone | 580-342-6228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH1702
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License Number State | OK
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