Organization
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Active
Other names
BRENTWOOD PLACE IV
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID K BYROM (CEO)
(254) 248-6300
Entity
Organization
Contact information
Practice address
3505 S BUCKNER BLVD BLDG 5, DALLAS, TX 75227-5451
(214) 381-1815
(214) 275-7618
Mailing address
3505 S BUCKNER BLVD BLDG 5, DALLAS, TX 75227-5451
(214) 381-1815
(214) 275-7618
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104549
—
TX
Enumeration date
01/20/2015
Last updated
01/20/2015
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