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General NPI Number Information
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NPI Number | 1316072192
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Entity Type | Organization
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Legal Business Name | HOME FOR AGED MASONS CLINIC NURSING CENTER
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 W DIVISION ST
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City | ARLINGTON
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State | TX
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Zip | 76012-3818
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Country | US
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Telephone | 817-275-2893
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Fax | 817-275-1065
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Provider Business Mailing Address
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Address Line | 1501 W DIVISION ST
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City | ARLINGTON
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State | TX
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Zip | 76012-3818
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Country | US
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Telephone | 817-275-2893
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Fax | 817-275-1065
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KIRBY RUDISILL
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Credential | ADMINISTRATOR
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Telephone | 817-275-2893
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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 | 0237
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License Number State | TX
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