Provider Demographics
NPI:1457681199
Name:MELROSE HCC, LLC
Entity Type:Organization
Organization Name:MELROSE HCC, LLC
Other - Org Name:MELROSE NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT SPECIALISTS
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-881-9432
Mailing Address - Street 1:1501 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-1404
Mailing Address - Country:US
Mailing Address - Phone:903-592-8148
Mailing Address - Fax:903-595-1253
Practice Address - Street 1:1501 W 29TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-1404
Practice Address - Country:US
Practice Address - Phone:903-592-8148
Practice Address - Fax:903-595-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4506Medicaid
TX001004885Medicaid
TX4506Medicaid