MEDICARE: PM MANAGEMENT - ROUND ROCK AL 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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1881086486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PM MANAGEMENT - ROUND ROCK AL LLC

Provider Business Mailing Address
First Line	:	600 N PEARL ST
Second Line	:	SUITE 1100
City	:	DALLAS
State	:	TX
Zip	:	75201-2822
Country	:	US
Telephone Number	:	214-252-7600
Fax Number	:	214-252-7599

Provider Business Practice Location Address
First Line	:	7230 WYOMING SPRINGS DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4319
Country	:	US
Telephone Number	:	512-765-7733
Fax Number	:	512-218-0073

Authorized Official
Title or Position	:	DIRECTOR OF RISK MANAGEMENT
Name	:	MS. WENDI ROGERS
Credential	:
Telephone Number	:	512-340-7829

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	10/24/2016

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