Provider Demographics
NPI:1366402430
Name:PREMONT NURSING HOME, INC.
Entity type:Organization
Organization Name:PREMONT NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MCCLEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-348-3553
Mailing Address - Street 1:PO BOX Q
Mailing Address - Street 2:
Mailing Address - City:PREMONT
Mailing Address - State:TX
Mailing Address - Zip Code:78375-0260
Mailing Address - Country:US
Mailing Address - Phone:361-348-3553
Mailing Address - Fax:361-348-3596
Practice Address - Street 1:431 N.W. 3RD STREET
Practice Address - Street 2:
Practice Address - City:PREMONT
Practice Address - State:TX
Practice Address - Zip Code:78375
Practice Address - Country:US
Practice Address - Phone:361-348-3553
Practice Address - Fax:361-348-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4487313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility