Provider Demographics
NPI:1598036717
Name:BOATRIGHT NURSING CENTERS INC
Entity Type:Organization
Organization Name:BOATRIGHT NURSING CENTERS INC
Other - Org Name:MISSION MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:BUMPASS
Authorized Official - Suffix:II
Authorized Official - Credentials:CPA
Authorized Official - Phone:903-389-1009
Mailing Address - Street 1:403 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1603
Mailing Address - Country:US
Mailing Address - Phone:903-389-1009
Mailing Address - Fax:903-389-1090
Practice Address - Street 1:501 YATES ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-3233
Practice Address - Country:US
Practice Address - Phone:903-537-4424
Practice Address - Fax:903-537-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675284Medicare Oscar/Certification