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NPI Code Detail

MEDICARE: PASADENA SENIOR CARE, LLC

MEDICARE: PASADENA SENIOR CARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1154850329
Entity Type Code : Organization
Provider Name (Legal Business Name) : PASADENA SENIOR CARE, LLC
Provider Business Mailing Address
First Line : 6500 HORIZON CIR
Second Line :
City : WACO
State : TX
Zip : 76712-6985
Country : US
Telephone Number : 254-399-6788
Fax Number :
Provider Business Practice Location Address
First Line : 4300 VISTA RD
Second Line :
City : PASADENA
State : TX
Zip : 77504-2118
Country : US
Telephone Number : 713-946-6787
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. JACK COOK
Credential :
Telephone Number : 254-399-6788
Provider Enumeration Date : 06/09/2017
Last Update Date : 06/09/2017

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Directions to “PASADENA SENIOR CARE, LLC ” Practice Location

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