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General NPI Number Information
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NPI Number | 1053547463
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Entity Type | Organization
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Legal Business Name | MASON DESSAU OP LLC
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 11020 DESSAU ROAD
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City | AUSTIN
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State | TX
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Zip | 78754-2053
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Country | US
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Telephone | 512-873-2244
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Fax | 512-873-2249
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Provider Business Mailing Address
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Address Line | 11020 DESSAU RD
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City | AUSTIN
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State | TX
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Zip | 78754-2053
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Country | US
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Telephone | 512-873-2244
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Fax | 512-873-2249
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RUSSELL A. CLARK
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Credential |
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Telephone | 512-873-2244
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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 | 135482
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License Number State | TX
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