Provider Demographics
NPI:1669459491
Name:CENTRAL TEXAS EQUITIES, INC.
Entity Type:Organization
Organization Name:CENTRAL TEXAS EQUITIES, INC.
Other - Org Name:MEMPHIS CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:806-259-3566
Mailing Address - Street 1:1415 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TX
Mailing Address - Zip Code:79245-2009
Mailing Address - Country:US
Mailing Address - Phone:806-259-3566
Mailing Address - Fax:806-259-5098
Practice Address - Street 1:1415 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TX
Practice Address - Zip Code:79245-2009
Practice Address - Country:US
Practice Address - Phone:806-259-3566
Practice Address - Fax:806-259-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115672314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675970Medicare ID - Type Unspecified