MEDICARE: AZLE MANOR HEALTH CARE, L.L.L.P.

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	314000000X	Skilled Nursing Facility	000119994	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982609269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZLE MANOR HEALTH CARE, L.L.L.P.

Provider Business Mailing Address
First Line	:	7150 GANTT ACCESS RD
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-5638
Country	:	US
Telephone Number	:	817-444-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 DUNAWAY LN
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020
Country	:	US
Telephone Number	:	817-444-2536
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	MAURA PANOS
Credential	:
Telephone Number	:	817-444-2516

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/03/2020

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