# TEXARKANA ELDER SERVICES, INC. DBA EDGEWOOD MANOR NURSING HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689662488
- **Authorized official:** MR. KYLE MARK DESHOTELS (PRESIDENT MEMBER)
- **Authorized official phone:** (870) 773-2376

## Contact information

- **Practice address:** 4925 ELIZABETH ST, TEXARKANA, TX 75503-2911
- **Practice address phone:** (903) 793-4645
- **Practice address fax:** (903) 793-3956
- **Mailing address:** 4925 ELIZABETH ST, TEXARKANA, TX 75503-2911
- **Mailing address phone:** (903) 793-4645
- **Mailing address fax:** (903) 793-3956

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 113456 | TX | Yes |

## Other

- **Enumeration date:** 10/06/2005
- **Last updated:** 06/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 005150 | FACILITY \# | TX |
| 05 | — | 113456 | — | TX |