Healthcare Provider Details

I. General information

NPI: 1982606174
Provider Name (Legal Business Name): CASCADE ANGELINA HEALTH SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 W FRANK AVE
LUFKIN TX
75904-3521
US

IV. Provider business mailing address

2414 W FRANK AVE
LUFKIN TX
75904-3521
US

V. Phone/Fax

Practice location:
  • Phone: 936-699-2544
  • Fax: 936-699-3355
Mailing address:
  • Phone: 936-699-2544
  • Fax: 936-699-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113565
License Number StateTX

VIII. Authorized Official

Name: MR. RONALD M HANEY
Title or Position: GENERAL PARTNER
Credential:
Phone: 936-634-6633