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General NPI Number Information
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NPI Number | 1528296662
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Entity Type | Organization
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Legal Business Name | TEXADA, INC
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Dates
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Enumeration Date | 06/28/2009
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 3202 S WILLIS ST
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City | ABILENE
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State | TX
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Zip | 79605-6650
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Country | US
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Telephone | 325-692-6145
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Fax | 325-692-6145
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Provider Business Mailing Address
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Address Line | 3202 S WILLIS ST
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City | ABILENE
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State | TX
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Zip | 79605-6650
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Country | US
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Telephone | 325-692-6145
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Fax | 325-695-2629
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARROLL BRUCE DAVIS
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Credential | PHD
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Telephone | 325-692-6145
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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 | 127499
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License Number State | TX
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