Provider Demographics
NPI:1902026446
Name:RED BIRD MANOR LLC
Entity Type:Organization
Organization Name:RED BIRD MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCOTT HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-566-9665
Mailing Address - Street 1:956 FM RD 757
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75705
Mailing Address - Country:US
Mailing Address - Phone:903-566-9665
Mailing Address - Fax:903-566-2419
Practice Address - Street 1:956 FM RD 757
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75705
Practice Address - Country:US
Practice Address - Phone:903-566-9665
Practice Address - Fax:903-566-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000933310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility