1881680106 NPI number — GAINESVILLE HEALTH CARE CENTER LTD. CO

Table of content: (NPI 1881680106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881680106 NPI number — GAINESVILLE HEALTH CARE CENTER LTD. CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAINESVILLE HEALTH CARE CENTER LTD. CO
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:
RENAISSANCE CARE CENTER
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:
1881680106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2537 GOLDEN BEAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75006-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-954-4114
Provider Business Mailing Address Fax Number:
214-871-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 BLACK HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-665-5221
Provider Business Practice Location Address Fax Number:
940-665-0306
Provider Enumeration Date:
09/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UNDERHILL
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE
Authorized Official Telephone Number:
214-954-4114

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  110722 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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