Healthcare Provider Details

I. General information

NPI: 1497745723
Provider Name (Legal Business Name): HERITAGE CONVALESCENT CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 CLYDE ST
AMARILLO TX
79106-4225
US

IV. Provider business mailing address

1009 CLYDE ST
AMARILLO TX
79106-4225
US

V. Phone/Fax

Practice location:
  • Phone: 806-352-5295
  • Fax: 806-352-6635
Mailing address:
  • Phone: 806-352-5295
  • Fax: 806-352-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. RUEGENA DAVIDSON
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 806-352-5295