Provider Demographics
NPI:1457879124
Name:MPD BENDER TERRACE OF LUBBOCK LLC
Entity Type:Organization
Organization Name:MPD BENDER TERRACE OF LUBBOCK LLC
Other - Org Name:BENDER TERRACE OF LUBBOCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-2140
Mailing Address - Street 1:1905 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4415
Mailing Address - Country:US
Mailing Address - Phone:318-812-2140
Mailing Address - Fax:
Practice Address - Street 1:4510 27TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1709
Practice Address - Country:US
Practice Address - Phone:806-795-4368
Practice Address - Fax:806-795-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility