Provider Demographics
NPI:1578509584
Name:PM MANAGEMENT-PORTLAND NC, LLC
Entity type:Organization
Organization Name:PM MANAGEMENT-PORTLAND NC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-252-7600
Mailing Address - Street 1:600 N PEARL ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7495
Mailing Address - Country:US
Mailing Address - Phone:214-252-7600
Mailing Address - Fax:214-252-7704
Practice Address - Street 1:221 CEDAR DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2900
Practice Address - Country:US
Practice Address - Phone:361-643-1888
Practice Address - Fax:361-777-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120859314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014379Medicaid
TX5391OtherFACILITY ID NO.
TX001014379Medicaid