East Texas Azalea Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EAST TEXAS AZALEA OPERATING COMPANY LLC

Practice address

810 S Porter Ave
Tyler, TX 75701-2300

Phone

(903) 593-2463

Fax

(903) 597-1203

NPI assigned

May 7, 2013

Organization subpart

No

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

Authorized official

Name

Carla Power

Title

Cfo

Phone

(903) 534-0523

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1770928434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 RICKETY LN",
            "address_2": "SUITE 208",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031702",
            "telephone_number": "903-534-0523",
            "fax_number": "903-534-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 S PORTER AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012300",
            "telephone_number": "903-593-2463",
            "fax_number": "903-597-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS AZALEA OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "POWER",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "903-534-0523"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001021267",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Tyler, TX
• Providers in Tyler, 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 Aug 6, 2013; 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.