Provider Demographics
NPI:1659514867
Name:S.U.R. LLC
Entity Type:Organization
Organization Name:S.U.R. LLC
Other - Org Name:ABILENE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-374-3804
Mailing Address - Street 1:9450 FM 2210 E
Mailing Address - Street 2:
Mailing Address - City:POOLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76487-5028
Mailing Address - Country:US
Mailing Address - Phone:940-374-3804
Mailing Address - Fax:940-374-3069
Practice Address - Street 1:2630 OLD ANSON RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-2210
Practice Address - Country:US
Practice Address - Phone:325-673-5101
Practice Address - Fax:325-673-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127476314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001017082Medicaid
TX004892OtherFACILITY ID
TX001017082Medicaid