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General NPI Number Information
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NPI Number | 1144500984
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Entity Type | Organization
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Legal Business Name | ENCHANTED HEARTS ADULT DAYCARE
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 2501 W OAK ST
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City | PALESTINE
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State | TX
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Zip | 75801-4069
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Country | US
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Telephone | 903-394-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 W OAK ST
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City | PALESTINE
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State | TX
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Zip | 75801-4069
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Country | US
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Telephone | 903-394-0071
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JACQUELINE LYNETTE WATKINS
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Credential |
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Telephone | 903-394-0071
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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 | 02182933
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License Number State | TX
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