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General NPI Number Information
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NPI Number | 1548381700
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN MANOR, INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 5100 STONE LAKE DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-8017
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Country | US
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Telephone | 940-689-7200
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Fax | 940-689-7220
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Provider Business Mailing Address
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Address Line | 5100 STONE LAKE DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-8017
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Country | US
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Telephone | 940-689-7200
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Fax | 940-689-7220
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BRYAN DUNCAN COONS
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Credential |
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Telephone | 940-689-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 102830
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License Number State | TX
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