Provider Demographics
NPI:1306221247
Name:MTR MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:MTR MANAGEMENT GROUP LLC
Other - Org Name:BENDER TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-795-4368
Mailing Address - Street 1:4510 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1709
Mailing Address - Country:US
Mailing Address - Phone:806-795-4368
Mailing Address - Fax:806-795-1189
Practice Address - Street 1:4510 27TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1709
Practice Address - Country:US
Practice Address - Phone:806-795-4368
Practice Address - Fax:806-795-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004072Medicaid
TX676163Medicare Oscar/Certification