Provider Demographics
NPI:1023674520
Name:HALL, EUNICE NADINE
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:NADINE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. TROUPE ST
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-8651
Mailing Address - Country:US
Mailing Address - Phone:903-887-2436
Mailing Address - Fax:903-887-0143
Practice Address - Street 1:110 W. TROUPE ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-8651
Practice Address - Country:US
Practice Address - Phone:903-887-2436
Practice Address - Fax:903-887-0143
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145465313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000425403Medicaid