Provider Demographics
NPI:1700025772
Name:BUCKNER RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:BUCKNER RETIREMENT SERVICES, INC.
Other - Org Name:BUCKNER HOSPICE - LONGVIEW
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:ED,D, 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:75201-2822
Mailing Address - Country:US
Mailing Address - Phone:214-758-8031
Mailing Address - Fax:214-758-8153
Practice Address - Street 1:2201 HORSESHOE LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5650
Practice Address - Country:US
Practice Address - Phone:903-234-0000
Practice Address - Fax:903-234-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient