Organization
MSHC BONNER STREET PLAZA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA POWER (CFO)
(903) 792-0838
Entity
Organization
Contact information
Practice address
421 S BONNER ST, JACKSONVILLE, TX 75766-2330
(903) 586-9871
Mailing address
421 BONNER STREET, JACKSONVILLE, TX 75766-2330
(903) 586-9871
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
129146
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005275
—
TX
Enumeration date
05/05/2011
Last updated
07/12/2011
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