Organization
EAST TEXAS AZALEA OPERATING COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA POWER (CFO)
(903) 534-0523
Entity
Organization
Contact information
Practice address
810 S PORTER AVE, TYLER, TX 75701-2300
(903) 593-2463
(903) 597-1203
Mailing address
1901 RICKETY LN, SUITE 208, TYLER, TX 75703-1702
(903) 534-0523
(903) 534-4705
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001021267
—
TX
Enumeration date
05/07/2013
Last updated
08/06/2013
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