Provider Demographics
NPI:1407853971
Name:BUCKNER RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:BUCKNER RETIREMENT SERVICES, INC.
Other - Org Name:PARKWAY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-758-8031
Mailing Address - Street 1:700 N PEARL ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1507
Mailing Address - Country:US
Mailing Address - Phone:281-556-9200
Mailing Address - Fax:281-556-9275
Practice Address - Street 1:1321 PARK BAYOU DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1507
Practice Address - Country:US
Practice Address - Phone:281-556-9200
Practice Address - Fax:281-556-9275
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUCKNER RETIREMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10294310400000X
TX109955314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004077Medicaid
TX004077Medicaid