Provider Demographics
NPI:1821163932
Name:HEALTHCARE MANAGEMENT PARTNERS OF DALLAS, LLC
Entity Type:Organization
Organization Name:HEALTHCARE MANAGEMENT PARTNERS OF DALLAS, LLC
Other - Org Name:COMMUNITY CARE CENTER OF CROCKETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-584-0719
Mailing Address - Street 1:201 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2016
Mailing Address - Country:US
Mailing Address - Phone:615-584-0719
Mailing Address - Fax:615-523-1835
Practice Address - Street 1:1150 E LOOP 304
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1810
Practice Address - Country:US
Practice Address - Phone:936-544-2051
Practice Address - Fax:936-544-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455577Medicare Oscar/Certification