Healthcare Provider Details

I. General information

NPI: 1972581882
Provider Name (Legal Business Name): HEARTWAY III CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 VALHALLA DR
WHARTON TX
77488-9218
US

IV. Provider business mailing address

1405 VALHALLA DR
WHARTON TX
77488-9218
US

V. Phone/Fax

Practice location:
  • Phone: 979-532-1244
  • Fax: 979-532-1142
Mailing address:
  • Phone: 979-532-1244
  • Fax: 979-532-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number112200
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID T. OBERGFELL
Title or Position: PRESIDENT, BOARD OF DIRECTORS
Credential:
Phone: 214-777-0282