Kilgore Manor Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

112798 Issued in TX

Legal business name

KILGORE MANOR INC

Practice address

2700 S Henderson Blvd
Kilgore, TX 75662-4033

Phone

(903) 984-3511

Fax

(903) 983-1031

NPI assigned

Sep 27, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Janice Pita

Title

Insurance/Medicare

Phone

(580) 622-6300

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Legacy Living Centers Doing business as

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1447246145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 S HENDERSON BLVD",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756624033",
            "telephone_number": "903-984-3511",
            "fax_number": "903-983-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 S HENDERSON BLVD",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756624033",
            "telephone_number": "903-984-3511",
            "fax_number": "903-983-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "PITA",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "INSURANCE/MEDICARE",
        "authorized_official_telephone_number": "580-622-6300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "112798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00102185",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "HH2539",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAID B",
            "identifier": "0220162-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Living Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kilgore Healthcare LLC
• Kilgore I Enterprises, LLC
• Kilgore Independent School District
• Kilgore Integrated Health PLLC
• Kilgore Life Center
• Kilgore Spine and Joint PLLC
• Kilgore-Gilmer Eye Care Centers P.a.
• Austin Knox, LPC ASSOCIATE
• Angela Solis Krenek, RPH
• Cynthia Kulak, P.T.

• Nursing Facility/Intermediate Care Facility in Kilgore, TX
• Providers in Kilgore, TX by specialty
• Nursing Facility/Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.