Healthcare Provider Details

I. General information

NPI: 1346237179
Provider Name (Legal Business Name): HOLIDAY LODGE 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

558 COUNTY ROAD 423
HASKELL TX
79521-9030
US

IV. Provider business mailing address

425 SW AVENUE F
HAMLIN TX
79520-4615
US

V. Phone/Fax

Practice location:
  • Phone: 940-864-2350
  • Fax:
Mailing address:
  • Phone: 325-576-3643
  • Fax: 325-576-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number675411
License Number StateTX

VIII. Authorized Official

Name: MRS. YOVNNE MARIE ROYSDON
Title or Position: DIRECTOR OF NURSING
Credential: REGISTERED NURSE
Phone: 325-576-3643