Provider Demographics
NPI:1063469674
Name:TEXARKANA NURSING & HEALTHCARE
Entity Type:Organization
Organization Name:TEXARKANA NURSING & HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-792-3812
Mailing Address - Street 1:4920 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2912
Mailing Address - Country:US
Mailing Address - Phone:903-792-3812
Mailing Address - Fax:903-792-9661
Practice Address - Street 1:4920 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2912
Practice Address - Country:US
Practice Address - Phone:903-792-3812
Practice Address - Fax:903-792-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115026364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001090Medicaid
TX001001090Medicaid