Pecan Manor Nursing and Rehabilitation LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

115249 Issued in TX

Legal business name

PECAN MANOR NURSING AND REHABILITATION LP

Practice address

413 Mansfield Cardinal Rd
Kennedale, TX 76060-2805

Phone

(817) 561-4495

Fax

(817) 561-6033

NPI assigned

Nov 4, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael A Rich

Title

President

Phone

(940) 387-4388

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1366433518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N ELM ST",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762014137",
            "telephone_number": "940-387-4388",
            "fax_number": "940-380-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 MANSFIELD CARDINAL RD",
            "city": "KENNEDALE",
            "state": "TX",
            "postal_code": "760602805",
            "telephone_number": "817-561-4495",
            "fax_number": "817-561-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN MANOR NURSING AND REHABILITATION LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "940-387-4388",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "115249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001004226",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TMHP (CROSS-OVER)",
            "identifier": "153326702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley L Navarre, LPC
• Shelly Nicholson, LVN
• Esther Bina Nyangau, NURSE
• Jacqueline Suzanne Parsons, MS
• Peachtree Residential Services
• Harveston Harshad Piggee II
• Iris Pineda, SA-C
• Plum Tree
• Jose Enrique Portales, ATC, LAT
• Greg Powers, LCSW

• All providers in Kennedale, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.