Provider Demographics
NPI:1164404075
Name:PHPM MISSION CARE CENTERS - NEW COVENANT LP
Entity Type:Organization
Organization Name:PHPM MISSION CARE CENTERS - NEW COVENANT LP
Other - Org Name:GARDEN VILLA NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LATTURE
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-731-3800
Mailing Address - Street 1:5420 W PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4823
Mailing Address - Country:US
Mailing Address - Phone:972-931-3800
Mailing Address - Fax:972-767-6222
Practice Address - Street 1:106 DEL NORTE DR
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-2504
Practice Address - Country:US
Practice Address - Phone:979-543-6762
Practice Address - Fax:979-543-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113790314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013031Medicaid
TX001013031Medicaid