Provider Demographics
NPI:1366502213
Name:PM MANAGEMENT-TEMPLE NC IV LLC
Entity Type:Organization
Organization Name:PM MANAGEMENT-TEMPLE NC IV LLC
Other - Org Name:TEMPLE LIVING CENTER EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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. FIFTH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703
Mailing Address - Country:US
Mailing Address - Phone:512-634-4900
Mailing Address - Fax:512-634-4950
Practice Address - Street 1:1511 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3338
Practice Address - Country:US
Practice Address - Phone:254-899-6500
Practice Address - Fax:254-899-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124554314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004737Medicaid
TX005132OtherFACILITY ID NO.
TX005132OtherFACILITY ID NO.