1821084138 NPI number — LIVINGSTON HEALTH CARE CENTER LTD. CO.

Table of content: (NPI 1821084138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821084138 NPI number — LIVINGSTON HEALTH CARE CENTER LTD. CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVINGSTON 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:
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:
1821084138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2008
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:
DALLAS
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:
301 WEST PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77351-8151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-327-4341
Provider Business Practice Location Address Fax Number:
936-327-6277
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:  114558 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 022634201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155314101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH068S . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000465804 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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