=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235407933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER TRANSITIONAL CARE ON HILLCREST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2011
-----------------------------------------------------
Last Update Date | 12/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18648 HILLCREST RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75252-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-517-7771
-----------------------------------------------------
Fax | 972-517-7779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7240 CHASE OAKS BLVD
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75025-5901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-517-6300
-----------------------------------------------------
Fax | 972-517-6301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | WILLIAM A THURMAN JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-517-6300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 134715
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------