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General NPI Number Information
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NPI Number | 1235237462
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Entity Type | Organization
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Legal Business Name | SOUTHHAVEN ENTERPRISES, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 5300 HOUSTON SCHOOL RD
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City | DALLAS
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State | TX
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Zip | 75241-1219
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Country | US
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Telephone | 214-372-1496
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Fax | 214-374-7333
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Provider Business Mailing Address
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Address Line | 5300 HOUSTON SCHOOL RD
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City | DALLAS
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State | TX
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Zip | 75241-1219
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Country | US
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Telephone | 214-372-1496
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Fax | 214-374-7333
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEE BATES
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Credential |
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Telephone | 940-864-3619
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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 | 4917
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License Number State | TX
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