Healthcare Provider Details

I. General information

NPI: 1295722015
Provider Name (Legal Business Name): CENTERVILLE HEALTHCARE 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

103 TEAKWOOD
CENTERVILLE TX
75833-2497
US

IV. Provider business mailing address

PO BOX 158
CENTERVILLE TX
75833-0158
US

V. Phone/Fax

Practice location:
  • Phone: 903-536-2596
  • Fax: 903-536-7609
Mailing address:
  • Phone: 903-536-2596
  • Fax: 903-536-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number110703
License Number StateTX

VIII. Authorized Official

Name: SHARON ANN RODELL
Title or Position: MEDICARE MANAGER
Credential: RN
Phone: 903-536-2596