Provider Demographics
NPI:1891019071
Name:J G & M LLC
Entity Type:Organization
Organization Name:J G & M LLC
Other - Org Name:BROWNWOOD SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
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:940-734-8304
Mailing Address - Fax:940-374-3069
Practice Address - Street 1:2700 MEMORIAL PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-8481
Practice Address - Country:US
Practice Address - Phone:325-643-9801
Practice Address - Fax:325-646-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001018771Medicaid
TX676278Medicare Oscar/Certification