Provider Demographics
NPI:1952461493
Name:PM MANAGEMENT-GEORGETOWN AL LLC
Entity Type:Organization
Organization Name:PM MANAGEMENT-GEORGETOWN AL LLC
Other - Org Name:PARK PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-634-4900
Mailing Address - Street 1:8701 N MO PAC EXPY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8376
Mailing Address - Country:US
Mailing Address - Phone:512-634-4900
Mailing Address - Fax:512-634-4950
Practice Address - Street 1:101 FM 971
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4546
Practice Address - Country:US
Practice Address - Phone:512-930-0730
Practice Address - Fax:512-948-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122277314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000319OtherFACILITY ID NO.