Provider Demographics
NPI:1043602642
Name:PM MANAGEMENT - SAN ANTONIO AL LLC
Entity Type:Organization
Organization Name:PM MANAGEMENT - SAN ANTONIO AL LLC
Other - Org Name:LAKESIDE ASSISTED LIVING BY TRISUN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-252-7703
Mailing Address - Street 1:600 N PEARL ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2822
Mailing Address - Country:US
Mailing Address - Phone:214-252-7600
Mailing Address - Fax:214-252-7599
Practice Address - Street 1:8627 LAKESIDE PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3261
Practice Address - Country:US
Practice Address - Phone:210-670-4900
Practice Address - Fax:210-670-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility