Provider Demographics
NPI:1689608614
Name:BUCKNER RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:BUCKNER RETIREMENT SERVICES, INC.
Other - Org Name:CALDER WOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,MS, MSN, RN
Authorized Official - Phone:214-758-8031
Mailing Address - Street 1:700 N PEARL ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2824
Mailing Address - Country:US
Mailing Address - Phone:214-758-8031
Mailing Address - Fax:214-758-8153
Practice Address - Street 1:7080 CALDER AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6052
Practice Address - Country:US
Practice Address - Phone:409-861-1123
Practice Address - Fax:409-861-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113507314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676109Medicare Oscar/Certification