Provider Demographics
NPI:1861675282
Name:TEXAS FAMILY TREE, LLC
Entity Type:Organization
Organization Name:TEXAS FAMILY TREE, LLC
Other - Org Name:PARIS NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:W
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-374-3804
Mailing Address - Street 1:9450 FM 2210 E
Mailing Address - Street 2:
Mailing Address - City:POOLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76487-5028
Mailing Address - Country:US
Mailing Address - Phone:940-374-3804
Mailing Address - Fax:940-374-3069
Practice Address - Street 1:2900 STILLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-0000
Practice Address - Country:US
Practice Address - Phone:903-785-1601
Practice Address - Fax:903-782-9534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676190Medicare Oscar/Certification