=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346204633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINNACLE HEALTH FACILITIES OF TEXAS XI LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2006
-----------------------------------------------------
Last Update Date | 02/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4195 MILAM ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77707-3918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-842-4550
-----------------------------------------------------
Fax | 409-840-2052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5420 W PLANO PKWY
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-931-3800
-----------------------------------------------------
Fax | 972-767-6222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REIMBURSEMENT
-----------------------------------------------------
Name | MRS. JAMIE LATTURE COLLIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-931-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 136044
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------