Provider Demographics
NPI:1467512004
Name:PM MANAGEMENT-AUSTIN NC II, LLC
Entity Type:Organization
Organization Name:PM MANAGEMENT-AUSTIN NC II, LLC
Other - Org Name:GRACY WOODS II LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-344-4235
Mailing Address - Street 1:1703 W 5TH ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4893
Mailing Address - Country:US
Mailing Address - Phone:512-344-4235
Mailing Address - Fax:877-639-9530
Practice Address - Street 1:12042 BITTERN HOLW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3350
Practice Address - Country:US
Practice Address - Phone:512-228-3350
Practice Address - Fax:512-228-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122585314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005356OtherFACILITY ID NO.
TX001003644Medicaid
TX675914Medicare Oscar/Certification