1437143211 NPI number — SOUTHWEST CARE ASSOCIATES LP

Table of content: (NPI 1437143211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437143211 NPI number — SOUTHWEST CARE ASSOCIATES LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST CARE ASSOCIATES LP
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:
MEL HAVEN CONVALESCENT HOME
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:
1437143211
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:
PO BOX 12322
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37912-0322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-938-4101
Provider Business Mailing Address Fax Number:
865-938-7230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 E 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORSICANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75110-8130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-874-7454
Provider Business Practice Location Address Fax Number:
903-872-0260
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DELORES
Authorized Official Middle Name:
Authorized Official Title or Position:
SEC'Y/TREAS UFM INC GEN PTR
Authorized Official Telephone Number:
865-938-4101

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  108533 , 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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