# HSMTX WATERTON PLAZA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Waterton Plaza Senior Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982886578
- **Authorized official:** CHARLES A DAVIS (VP FINANCE)
- **Authorized official phone:** (713) 934-7800

## Contact information

- **Practice address:** 2875 SHILOH RD, TYLER, TX 75703-2936
- **Practice address phone:** (903) 561-1300
- **Practice address fax:** (903) 939-1754
- **Mailing address:** 5300 HOLLISTER ST, SUITE 550, HOUSTON, TX 77040-6137
- **Mailing address phone:** (713) 934-7800
- **Mailing address fax:** (713) 895-0064

## Taxonomy

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

## Other

- **Enumeration date:** 12/05/2007
- **Last updated:** 02/16/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001017767 | — | TX |