Healthcare Provider Details

I. General information

NPI: 1457384224
Provider Name (Legal Business Name): TRAVIS HEIGHTS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15336 US HIGHWAY 82 WEST
MUENSTER TX
76252
US

IV. Provider business mailing address

PO BOX 746
MUENSTER TX
76252-0746
US

V. Phone/Fax

Practice location:
  • Phone: 940-759-2219
  • Fax: 940-759-4382
Mailing address:
  • Phone: 940-759-2219
  • Fax: 940-759-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number122427
License Number StateTX

VIII. Authorized Official

Name: MR. LOUIS FREDERCICK NICHOLSON III
Title or Position: CEO
Credential: LNFA
Phone: 832-489-9944