Organization
PINE RIDGE HEALTH CARE L L P
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURA PANOS (ACCOUNTANT)
(817) 444-2516
Entity
Organization
Contact information
Practice address
1620 HIGHWAY 59 LOOP N, LIVINGSTON, TX 77351-9988
(936) 327-5415
Mailing address
7150 GANTT ACCESS, AZLE, TX 76020-5638
(817) 444-2516
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
113069
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001001771
—
TX
Enumeration date
06/14/2005
Last updated
08/03/2020
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