Provider Demographics
NPI:1083919856
Name:PM MANAGEMENT - KILLEEN IV NC LLC
Entity Type:Organization
Organization Name:PM MANAGEMENT - KILLEEN IV NC LLC
Other - Org Name:WIND CREST REHAB AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-634-4900
Mailing Address - Street 1:1703 W 5TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4893
Mailing Address - Country:US
Mailing Address - Phone:512-634-4900
Mailing Address - Fax:512-634-4966
Practice Address - Street 1:607 W AVE B
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1553
Practice Address - Country:US
Practice Address - Phone:254-547-1033
Practice Address - Fax:254-542-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131729314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005154OtherFACILITY ID
TX001019294Medicaid
TX005154OtherFACILITY ID