Southwest LTC Park Manor II LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

005257 Issued in TX

Legal business name

SOUTHWEST LTC PARK MANOR II LTD

Practice address

207 E Parkerville Rd
Desoto, TX 75115-6251

Phone

(972) 230-1000

Fax

(972) 230-5509

NPI assigned

Dec 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Sammy Gore

Title

Administrator

Phone

(972) 230-1000

Specialties & licenses 1

Addresses

Other names 1

• DBA PARK MANOR HEALTHCARE Doing business as

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225196405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 E PARKERVILLE RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751156251",
            "telephone_number": "972-230-1000",
            "fax_number": "972-230-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E PARKERVILLE RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751156251",
            "telephone_number": "972-230-1000",
            "fax_number": "972-230-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC PARK MANOR II LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "SAMMY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-230-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "005257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA PARK MANOR HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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.