# EAST TEXAS AZALEA OPERATING COMPANY LLC

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

## Provider details

- **NPI number:** 1770928434
- **Authorized official:** CARLA POWER (CFO)
- **Authorized official phone:** (903) 534-0523

## Contact information

- **Practice address:** 810 S PORTER AVE, TYLER, TX 75701-2300
- **Practice address phone:** (903) 593-2463
- **Practice address fax:** (903) 597-1203
- **Mailing address:** 1901 RICKETY LN, SUITE 208, TYLER, TX 75703-1702
- **Mailing address phone:** (903) 534-0523
- **Mailing address fax:** (903) 534-4705

## Taxonomy

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

## Other

- **Enumeration date:** 05/07/2013
- **Last updated:** 08/06/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001021267 | — | TX |