1083679666 NPI number — GOLDTHWAITE SENIOR HEALTH CENTER, INC

Table of content: (NPI 1083679666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083679666 NPI number — GOLDTHWAITE SENIOR HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDTHWAITE SENIOR HEALTH CENTER, INC
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:
6
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:
1083679666
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:
1515 HERITAGE DR
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75069-3256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-256-3787
Provider Business Mailing Address Fax Number:
214-256-3789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1207 S REYNOLDS
Provider Second Line Business Practice Location Address:
POB 607
Provider Business Practice Location Address City Name:
GOLDTHWAITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-648-2258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRASWELL
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
214-256-3787

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  4411 , 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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