Provider Demographics
NPI:1952723157
Name:TEX TAIL, INC.
Entity Type:Organization
Organization Name:TEX TAIL, INC.
Other - Org Name:COUNTRY MANOR ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-719-3548
Mailing Address - Street 1:2806 W SAM ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5518
Mailing Address - Country:US
Mailing Address - Phone:813-719-3548
Mailing Address - Fax:813-759-9513
Practice Address - Street 1:2806 W SAM ALLEN RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33565-5518
Practice Address - Country:US
Practice Address - Phone:813-719-3548
Practice Address - Fax:813-759-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8925310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility