Healthcare Provider Details

I. General information

NPI: 1528057858
Provider Name (Legal Business Name): SENIOR MANAGEMENT SERVICES OF HERITAGE OAKS AT BALLINGER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N 6TH ST
BALLINGER TX
76821-2500
US

IV. Provider business mailing address

800 W ARBROOK BLVD STE 210
ARLINGTON TX
76015-4327
US

V. Phone/Fax

Practice location:
  • Phone: 325-365-5766
  • Fax: 325-365-5449
Mailing address:
  • Phone: 817-468-1991
  • Fax: 817-468-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114911
License Number StateTX

VIII. Authorized Official

Name: TROY CLANTON
Title or Position: PRESIDENT
Credential:
Phone: 817-468-1991