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General NPI Number Information
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NPI Number | 1063760361
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Entity Type | Organization
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Legal Business Name | TICKNOR ENTERPRISES STEPHENVILLE, LLC
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2311 WEST WASHINGTON STREET
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City | STEPHENVILLE
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State | TX
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Zip | 76401-3805
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Country | US
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Telephone | 254-968-3313
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Fax | 682-305-7155
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Provider Business Mailing Address
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Address Line | 4150 INTERNATIONAL PLAZA SUITE 102
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City | FORT WORTH
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State | TX
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Zip | 76109-4846
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Country | US
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Telephone | 682-305-7150
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Fax | 682-318-1799
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Authorized Official
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Title or Position | MANAGER
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Name | MR. LEON EVANS
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Credential |
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Telephone | 682-305-7150
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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 |
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License Number State |
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