Provider Demographics
NPI:1518003540
Name:MESA SPRINGS RETIREMENT VILLAGE, INC.
Entity Type:Organization
Organization Name:MESA SPRINGS RETIREMENT VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-2182
Mailing Address - Street 1:7171 BUFFALO GAP RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5450
Mailing Address - Country:US
Mailing Address - Phone:325-670-2182
Mailing Address - Fax:325-692-6228
Practice Address - Street 1:7171 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5450
Practice Address - Country:US
Practice Address - Phone:325-670-2182
Practice Address - Fax:325-692-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117944314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000537801Medicaid
TX000673800Medicaid
TX000673800Medicaid