Provider Demographics
NPI:1548241466
Name:TOWN & COUNTRY MANOR, LP
Entity Type:Organization
Organization Name:TOWN & COUNTRY MANOR, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-249-3085
Mailing Address - Street 1:625 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1621
Mailing Address - Country:US
Mailing Address - Phone:830-249-3085
Mailing Address - Fax:830-249-8033
Practice Address - Street 1:625 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1621
Practice Address - Country:US
Practice Address - Phone:830-249-3085
Practice Address - Fax:830-249-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX455796314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5796Medicare ID - Type UnspecifiedMEDICARE NUMBER