Provider Demographics
NPI:1548381700
Name:PRESBYTERIAN MANOR, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN MANOR, INC.
Other - Org Name:EARLE W. CRAWFORD - HOUSE OF HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-689-7200
Mailing Address - Street 1:5100 STONE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-8017
Mailing Address - Country:US
Mailing Address - Phone:940-689-7200
Mailing Address - Fax:940-689-7220
Practice Address - Street 1:5100 STONE LAKE DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-8017
Practice Address - Country:US
Practice Address - Phone:940-689-7200
Practice Address - Fax:940-689-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102830311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)