1497702211 NPI number — FAIRVIEW HEALTHCARE RESIDENCE LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497702211 NPI number — FAIRVIEW HEALTHCARE RESIDENCE LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW HEALTHCARE RESIDENCE LTD.
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:
Provider Other Organization Name Type Code:
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:
1497702211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2524 AUSTIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76710-7418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-753-7367
Provider Business Mailing Address Fax Number:
254-753-5776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E REUNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75840-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-389-4121
Provider Business Practice Location Address Fax Number:
903-389-7066
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARWITZ
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT, COO FHCR INC. GEN. PTR.
Authorized Official Telephone Number:
254-753-7367

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  113530 , 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)





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