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Organization
KRISTI LEE MANOR INC
Active
Organization
KRISTI LEE MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK MOODY (ADMINISTRATOR OWNER)
(325) 728-5247
Entity
Organization
Contact information
Practice address
1941 CHESTNUT ST, COLORADO CITY, TX 79512-3099
(325) 728-5247
(325) 728-2611
Mailing address
1941 CHESTNUT ST, COLORADO CITY, TX 79512-3099
(325) 728-5247
(325) 728-2611
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
111707
TX
314000000X
Skilled Nursing Facility
676027
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45E123
—
TX
Enumeration date
08/31/2006
Last updated
04/12/2010
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