Organization
AZALEA PLACE OPERATING COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ANN HUNTER (BUSINESS OFFICE MANAGER)
(903) 593-2463
Entity
Organization
Contact information
Practice address
810 S PORTER AVE, TYLER, TX 75701-2300
(903) 593-2463
(903) 597-1203
Mailing address
810 S PORTER AVE, TYLER, TX 75701-2300
(903) 593-2463
(903) 597-1203
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
4734
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4734
VENDOR ID#
TX
Enumeration date
02/09/2007
Last updated
08/22/2020
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