Healthcare Provider Details

I. General information

NPI: 1598708497
Provider Name (Legal Business Name): HEARTHSTONE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OAKWOOD BLVD
ROUND ROCK TX
78681-4067
US

IV. Provider business mailing address

401 OAKWOOD BLVD
ROUND ROCK TX
78681-4067
US

V. Phone/Fax

Practice location:
  • Phone: 512-388-7494
  • Fax: 512-388-2166
Mailing address:
  • Phone: 512-388-7494
  • Fax: 512-388-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number005264
License Number StateTX

VIII. Authorized Official

Name: MR. DOUGLAS M HOWERTON
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 512-703-2193