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General NPI Number Information
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NPI Number | 1891754222
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Entity Type | Organization
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Legal Business Name | TYRRELL ADULT CARE
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 5733 MEL SHA LN
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City | BEAUMONT
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State | TX
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Zip | 77705-6806
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Country | US
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Telephone | 409-350-9933
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Fax | 409-840-9435
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Provider Business Mailing Address
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Address Line | 5733 MEL SHA LN
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City | BEAUMONT
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State | TX
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Zip | 77705-6806
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Country | US
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Telephone | 409-350-9933
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Fax | 409-840-9435
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. EPPIE B HILL
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Credential | OWNER
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Telephone | 409-350-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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