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Organization

PONDEROSA NURSING AND REHABILIATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BEVERLY HAGOOD LNFA (ADMINISTATOR)
(903) 667-2572
Entity
Organization

Contact information

Practice address
12520 FM 1840, DE KALB, TX 75559-1929
(903) 667-2572
Mailing address
12520 FM 1840, DE KALB, TX 75559-1929
(903) 667-2572

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
001021048
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001021048
TX
Enumeration date
10/17/2016
Last updated
10/17/2016
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