Provider Demographics
NPI:1528100898
Name:TAYLOR CARE CENTER
Entity type:Organization
Organization Name:TAYLOR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-561-6755
Mailing Address - Street 1:P.O. BOX 210003
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095
Mailing Address - Country:US
Mailing Address - Phone:682-561-6755
Mailing Address - Fax:
Practice Address - Street 1:212 EAST LAKE DR.
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574
Practice Address - Country:US
Practice Address - Phone:512-365-8856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45E034313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45E034Medicaid