Texas Ahcs 2, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

115304 Issued in TX

Legal business name

TEXAS AHCS 2, LP

Doing business as

Park Plaza

Practice address

1201 E McLennan Ave
Mart, TX 76664-1232

Phone

(254) 876-2531

NPI assigned

Nov 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alan D Peterson, LNFA

Title

President

Phone

(817) 919-7495

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park Plaza Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114099413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 E MCLENNAN AVE",
            "city": "MART",
            "state": "TX",
            "postal_code": "766641232",
            "telephone_number": "254-876-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E MCLENNAN AVE",
            "city": "MART",
            "state": "TX",
            "postal_code": "766641232",
            "telephone_number": "254-876-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS AHCS 2, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-919-7495",
        "authorized_official_credential": "LNFA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "115304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4482",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtney Moltzer, M. ED., LPC, LCDC
• Haley Anne Pankonien, MS SLP-INTERN
• Sarada Devi Pokuri, PH.D.
• South Limestone Hospital District (Rucker Clinic A Limestone Medical Center Clinic)
• Eric Steinke
• Teresa Ann Wheeler
• Emily Witt
• Richard Lee Yates, MS, LPC

• Skilled Nursing Facility in Mart, TX
• Providers in Mart, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.