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General NPI Number Information
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NPI Number | 1629163860
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Entity Type | Organization
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Legal Business Name | PECAN GROVE HEALTH CARE LP
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1106 GOLFVIEW DR
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City | RICHMOND
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State | TX
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Zip | 77469-5120
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Country | US
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Telephone | 281-344-9191
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Fax | 830-597-5361
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Provider Business Mailing Address
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Address Line | 1106 GOLFVIEW DR P.O. BOX 1189
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City | RICHMOND
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State | TX
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Zip | 77469-5120
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Country | US
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Telephone | 281-344-9191
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Fax | 830-597-5361
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. TAMARA D SCOTCH
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Credential |
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Telephone | 830-597-5445
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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 | 5273
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License Number State | TX
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