Provider Demographics
NPI:1114099413
Name:TEXAS AHCS 2, LP
Entity Type:Organization
Organization Name:TEXAS AHCS 2, LP
Other - Org Name:PARK PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:817-919-7495
Mailing Address - Street 1:1201 E MCLENNAN AVE
Mailing Address - Street 2:
Mailing Address - City:MART
Mailing Address - State:TX
Mailing Address - Zip Code:76664-1232
Mailing Address - Country:US
Mailing Address - Phone:254-876-2531
Mailing Address - Fax:
Practice Address - Street 1:1201 E MCLENNAN AVE
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-1232
Practice Address - Country:US
Practice Address - Phone:254-876-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115304314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4482Medicaid
TX4482Medicaid