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General NPI Number Information
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NPI Number | 1255502795
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Entity Type | Organization
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Legal Business Name | MSPF-IV MANSFIELD OE, LP
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 301 N MILLER RD
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City | MANSFIELD
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State | TX
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Zip | 76063-9144
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Country | US
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Telephone | 817-276-4800
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Fax | 817-276-4850
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Provider Business Mailing Address
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Address Line | 3811 TURTLE CREEK BLVD SUITE 1850
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City | DALLAS
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State | TX
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Zip | 75219-4402
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Country | US
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Telephone | 214-651-4050
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Fax | 214-651-4001
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID RONCK
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Credential |
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Telephone | 214-651-4050
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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 | 120626
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License Number State | TX
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