Healthcare Provider Details

I. General information

NPI: 1508853334
Provider Name (Legal Business Name): CANTONHEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 S BUFFALO ST
CANTON TX
75103-2619
US

IV. Provider business mailing address

1661 S BUFFALO ST
CANTON TX
75103-2619
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-4135
  • Fax: 903-567-1077
Mailing address:
  • Phone: 903-567-4135
  • Fax: 903-567-1077

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: MRS. LORI MARIE JONES
Title or Position: MDS COORDINATOR
Credential: RN
Phone: 903-567-4135