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NPI Code Detail

MEDICARE: GIBBONS TX MANAGEMENT LLC

MEDICARE: GIBBONS TX MANAGEMENT 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 FacilityTX

General Provider Information

NPI Number : 1528447638
Entity Type Code : Organization
Provider Name (Legal Business Name) : GIBBONS TX MANAGEMENT LLC
Provider Business Mailing Address
First Line : 1112 GIBBINS RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-5618
Country : US
Telephone Number : 817-274-2584
Fax Number :
Provider Business Practice Location Address
First Line : 1112 GIBBINS RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-5618
Country : US
Telephone Number : 817-274-2584
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : ELIE DEITSCH
Credential :
Telephone Number : 516-596-5222
Provider Enumeration Date : 05/21/2015
Last Update Date : 06/30/2015

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Directions to “GIBBONS TX MANAGEMENT LLC ” Practice Location

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