1891792834 NPI number — HEALTHCARE CENTER OF HENDERSON

Table of content: (NPI 1891792834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891792834 NPI number — HEALTHCARE CENTER OF HENDERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE CENTER OF HENDERSON
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:
SOUTHWOOD NURSING & REHABILITATION
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:
1891792834
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 7230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77903-7230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-576-9454
Provider Business Mailing Address Fax Number:
361-576-2994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SOUTHWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75654-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-657-6506
Provider Business Practice Location Address Fax Number:
903-655-8578
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
361-576-9454

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  110773 , 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)

  • Identifier: 4894720001 . This is a "DMERC PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4912 . This is a "VENDOR NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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