Healthcare Provider Details

I. General information

NPI: 1750377073
Provider Name (Legal Business Name): MATHIS HEALTH CARE CENTER LTD. CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LOOP 459
MATHIS TX
78368-1804
US

IV. Provider business mailing address

2537 GOLDEN BEAR DR
CARROLLTON TX
75006-2377
US

V. Phone/Fax

Practice location:
  • Phone: 361-547-3318
  • Fax: 361-547-3737
Mailing address:
  • Phone: 214-954-4114
  • Fax: 214-871-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number108260
License Number StateTX

VIII. Authorized Official

Name: MRS. ROBIN UNDERHILL
Title or Position: CHIEF EXECUTIVE
Credential:
Phone: 214-954-4114