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General NPI Number Information
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NPI Number | 1467439976
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Entity Type | Organization
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Legal Business Name | SOUTHWEST LTC--BRADY WEST, LTD.
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2201 MENARD HWY
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City | BRADY
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State | TX
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Zip | 76825-7432
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Country | US
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Telephone | 325-597-2906
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Fax | 325-597-2555
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Provider Business Mailing Address
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Address Line | 17760 PRESTON RD SUITE 310
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City | DALLAS
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State | TX
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Zip | 75252-5663
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Country | US
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Telephone | 469-916-6100
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Fax | 469-916-6105
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. RONALD R. PAYNE
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Credential | ESQ.
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Telephone | 469-916-6100
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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 | 004744
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License Number State | TX
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