Provider Demographics
NPI:1609806579
Name:LEE BIVINS FOUNDATION
Entity Type:Organization
Organization Name:LEE BIVINS FOUNDATION
Other - Org Name:BIVINS POINTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-379-9400
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-1727
Mailing Address - Country:US
Mailing Address - Phone:806-379-9400
Mailing Address - Fax:806-379-9404
Practice Address - Street 1:6600 KILLGORE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-3700
Practice Address - Country:US
Practice Address - Phone:806-350-2200
Practice Address - Fax:806-354-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112385314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012218Medicaid
TX001012218Medicaid