Healthcare Provider Details

I. General information

NPI: 1861480147
Provider Name (Legal Business Name): ROSCOE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CYPRESS ST
ROSCOE TX
79545-2877
US

IV. Provider business mailing address

201 CYPRESS ST
ROSCOE TX
79545-2877
US

V. Phone/Fax

Practice location:
  • Phone: 325-766-3374
  • Fax: 325-766-3159
Mailing address:
  • Phone: 325-766-3374
  • Fax: 325-766-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4087
License Number StateTX

VIII. Authorized Official

Name: MS. DEBORAH DURANN GANSEL
Title or Position: ADMINISTRATOR
Credential: LNFA
Phone: 325-766-3374