Texarkana Elder Services, Inc. Dba Edgewood Manor Nursing Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

113456 Issued in TX

Legal business name

TEXARKANA ELDER SERVICES, INC. DBA EDGEWOOD MANOR NURSING HOME

Practice address

4925 Elizabeth St
Texarkana, TX 75503-2911

Phone

(903) 793-4645

Fax

(903) 793-3956

NPI assigned

Oct 6, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Kyle Mark Deshotels

Title

President Member

Phone

(870) 773-2376

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1689662488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 ELIZABETH ST",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032911",
            "telephone_number": "903-793-4645",
            "fax_number": "903-793-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 ELIZABETH ST",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032911",
            "telephone_number": "903-793-4645",
            "fax_number": "903-793-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXARKANA ELDER SERVICES, INC. DBA EDGEWOOD MANOR NURSING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "DESHOTELS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT MEMBER",
        "authorized_official_telephone_number": "870-773-2376",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "113456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY #",
            "identifier": "005150",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113456",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Texarkana Emergency Center, LLC (SignatureCare Emergency Centers, LLC)
• Texarkana Emergency Medicine Physicians,PA
• Texarkana Emergency Physicians PLLC
• Texarkana ER, LLC (Texarkana Emergency Center & Hospital)
• Texarkana Eye Associates

• Skilled Nursing Facility in Texarkana, TX
• Providers in Texarkana, 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 Jun 24, 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.