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General NPI Number Information
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NPI Number | 1912974866
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Entity Type | Organization
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Legal Business Name | MANOR PARK, INC
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 2208 N LOOP 250 W
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City | MIDLAND
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State | TX
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Zip | 79707-6011
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Country | US
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Telephone | 432-689-9898
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Fax | 432-694-2551
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Provider Business Mailing Address
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Address Line | 2208 N LOOP 250 W
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City | MIDLAND
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State | TX
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Zip | 79707-6011
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Country | US
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Telephone | 432-689-9898
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Fax | 432-694-2551
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MR. STEPHEN NELSON
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Credential |
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Telephone | 432-689-9898
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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 | 116128
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 116128
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License Number State | TX
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