Provider Demographics
NPI:1952565624
Name:MARSHALL SENIOR CARE LLC
Entity Type:Organization
Organization Name:MARSHALL SENIOR CARE LLC
Other - Org Name:MARSHALL MANOR NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-935-7971
Mailing Address - Street 1:1007 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5333
Mailing Address - Country:US
Mailing Address - Phone:903-935-7971
Mailing Address - Fax:903-935-1908
Practice Address - Street 1:1007 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5333
Practice Address - Country:US
Practice Address - Phone:903-935-7971
Practice Address - Fax:903-935-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120459314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1227340001Medicare NSC