Provider Demographics
NPI:1801979455
Name:MORNINGSTAR OPERATING #4, LTD
Entity type:Organization
Organization Name:MORNINGSTAR OPERATING #4, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-363-1005
Mailing Address - Street 1:318 BRIAR ROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-363-1005
Mailing Address - Fax:281-292-2092
Practice Address - Street 1:302 LINCOLN PARK DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7015
Practice Address - Country:US
Practice Address - Phone:817-558-4787
Practice Address - Fax:817-556-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114958314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455988Medicare ID - Type UnspecifiedPROVIDER NUMBER