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Organization
PONDEROSA NURSING AND REHABILIATION
Active
Organization
PONDEROSA NURSING AND REHABILIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY HAGOOD LNFA (ADMINISTATOR)
(903) 667-2572
Entity
Organization
Contact information
Practice address
12520 FM 1840, DE KALB, TX 75559-1929
(903) 667-2572
Mailing address
12520 FM 1840, DE KALB, TX 75559-1929
(903) 667-2572
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
001021048
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001021048
—
TX
Enumeration date
10/17/2016
Last updated
10/17/2016
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