Teakwood Manor, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

117297 Issued in TX

Legal business name

TEAKWOOD MANOR, LLC

Practice address

1003 Columbia St
Stamford, TX 79553-6825

Phone

(325) 773-3671

Fax

(325) 773-5751

NPI assigned

Jun 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Lee F. Smith

Title

President

Phone

(940) 692-8977

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154362887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4723 TAFT BLVD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763085001",
            "telephone_number": "940-692-8977",
            "fax_number": "940-692-8567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 COLUMBIA ST",
            "city": "STAMFORD",
            "state": "TX",
            "postal_code": "795536825",
            "telephone_number": "325-773-3671",
            "fax_number": "325-773-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEAKWOOD MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "940-692-8977",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "117297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VENDOR NUMBER",
            "identifier": "4930",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.