1134328396 NPI number — HAMILTON RIDGE OPERATIONS, LLC

Table of content: (NPI 1134328396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134328396 NPI number — HAMILTON RIDGE OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON RIDGE OPERATIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOVE HILL CARE CENTER & VILLAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134328396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 W 7TH STREET, SUITE 415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-335-4111
Provider Business Mailing Address Fax Number:
817-335-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 E. STATE HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-386-3171
Provider Business Practice Location Address Fax Number:
254-386-8261
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-335-4111

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 1015270 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001015270 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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