Healthcare Provider Details

I. General information

NPI: 1124014428
Provider Name (Legal Business Name): SEAGO HEALTH CARE CENTER LTD. CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 ELIZABETH LN
SEAGOVILLE TX
75159-2702
US

IV. Provider business mailing address

2537 GOLDEN BEAR DR
DALLAS TX
75006-2377
US

V. Phone/Fax

Practice location:
  • Phone: 972-287-2491
  • Fax: 972-287-6693
Mailing address:
  • Phone: 214-954-4114
  • Fax: 214-871-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number109485
License Number StateTX

VIII. Authorized Official

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