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General NPI Number Information
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NPI Number | 1104947811
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Entity Type | Organization
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Legal Business Name | TOWN HALL ESTATES-KEENE INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 207 S OLD BETSY RD
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City | KEENE
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State | TX
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Zip | 76059-2426
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Country | US
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Telephone | 817-645-8888
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Fax | 817-645-4984
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Provider Business Mailing Address
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Address Line | PO BOX 588
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City | KEENE
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State | TX
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Zip | 76059-0588
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Country | US
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Telephone | 817-645-8888
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Fax | 817-645-4984
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIAM JASON FAUTHEREE
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Credential |
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Telephone | 817-645-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 116903
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 116903
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License Number State | TX
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