Provider Demographics
NPI:1851488928
Name:PINNACLE HEALTH FACILITIES XV LP
Entity Type:Organization
Organization Name:PINNACLE HEALTH FACILITIES XV LP
Other - Org Name:LEXINGTON PLACE NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LATTURE
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-931-3800
Mailing Address - Street 1:5420 W PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4823
Mailing Address - Country:US
Mailing Address - Phone:972-931-3800
Mailing Address - Fax:972-976-6222
Practice Address - Street 1:1661 W YOAKUM AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4431
Practice Address - Country:US
Practice Address - Phone:361-758-7686
Practice Address - Fax:361-758-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
TX119516313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014603Medicaid
455728Medicare Oscar/Certification