SOUTHWEST LTC--PARK MANOR II, LTD. (PARK MANOR HEALTH CARE AND REHABILITATION) - NPI NUMBER 1225022908

Summary

Provider Name: SOUTHWEST LTC--PARK MANOR II, LTD. (PARK MANOR HEALTH CARE AND REHABILITATION)

NPI Number: 1225022908

Clasification: Skilled Nursing Facility (314000000X)

Address:
207 E PARKERVILLE RD
DESOTO, TX
ZIP 75115

Phone Number: (972) 230-1000



Detailed Information

SOUTHWEST LTC--PARK MANOR II, LTD. is a skilled nursing facility in Desoto, TX. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. The assigned NPI number for this provider is 1225022908 and is registered as an organization entity type.
The provider Is Doing Business As Park Manor Health Care And Rehabilitation.

The provider's business address is:

207 E PARKERVILLE RD
DESOTO, TX
ZIP 75115-251
Phone: (972) 230-1000
Fax: (972) 230-5509

The provider's authorized official is Ronald R Payne .
The authorized official title is Ceo and has the following contact phone number (469) 916-6100.

The enumeration date for this NPI number is 9/8/2005 and was last updated on 7/8/2007.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 314000000X Skilled Nursing Facility 111200 TX Yes

NPI Record

No. Field Name Field Value
1 NPI 1225022908
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name SOUTHWEST LTC--PARK MANOR II, LTD.
5 Provider Other Organization Name PARK MANOR HEALTH CARE AND REHABILITATION
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 207 E PARKERVILLE RD
8 Provider Business Practice Location Address City Name DESOTO
9 Provider Business Practice Location Address State Name TX
10 Provider Business Practice Location Address Postal Code 751156251
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 9722301000
13 Provider Business Practice Location Address Fax Number 9722305509
14 Provider Enumeration Date 9/8/2005
15 Last Update Date 7/8/2007
16 Authorized Official Last Name PAYNE
17 Authorized Official First Name RONALD
18 Authorized Official Middle Name R
19 Authorized Official Title or Position CEO
20 Authorized Official Telephone Number 4699166100
21 Healthcare Provider Taxonomy Code 1 314000000X
22 Provider License Number 1 111200
23 Provider License Number State Code 1 TX
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Authorized Official Credential Text ESQ.

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This page was last updated on: 10/12/2014
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