Provider Demographics
NPI:1750833901
Name:CITY OF ENNIS
Entity Type:Organization
Organization Name:CITY OF ENNIS
Other - Org Name:ROYSE CITY MEDICAL LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-875-1234
Mailing Address - Street 1:901 W INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-7518
Mailing Address - Country:US
Mailing Address - Phone:972-636-9100
Mailing Address - Fax:972-626-7424
Practice Address - Street 1:901 W INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-7518
Practice Address - Country:US
Practice Address - Phone:972-636-9100
Practice Address - Fax:972-626-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility