Healthcare Provider Details

I. General information

NPI: 1003898263
Provider Name (Legal Business Name): HERITAGE HOUSE NURSING AND REHABILITATION LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N. COLLEGE STREET
ROSEBUD TX
76570-0656
US

IV. Provider business mailing address

401 N ELM ST
DENTON TX
76201-4137
US

V. Phone/Fax

Practice location:
  • Phone: 254-583-7904
  • Fax: 254-583-2830
Mailing address:
  • Phone: 940-387-4388
  • Fax: 940-380-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number115577
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL A. RICH
Title or Position: PRESIDENT
Credential:
Phone: 940-387-4388