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General NPI Number Information
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NPI Number | 1578509584
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Entity Type | Organization
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Legal Business Name | PM MANAGEMENT-PORTLAND NC, LLC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 221 CEDAR DR
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City | PORTLAND
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State | TX
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Zip | 78374-2900
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Country | US
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Telephone | 361-643-1888
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Fax | 361-777-3419
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Provider Business Mailing Address
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Address Line | 600 N PEARL ST STE 1050
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City | DALLAS
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State | TX
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Zip | 75201-7495
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Country | US
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Telephone | 214-252-7600
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Fax | 214-252-7704
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MICHAEL BEAL
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Credential |
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Telephone | 214-252-7600
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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 | 120859
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License Number State | TX
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