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General NPI Number Information
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NPI Number | 1295722015
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Entity Type | Organization
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Legal Business Name | CENTERVILLE HEALTHCARE CENTER
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 TEAKWOOD
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City | CENTERVILLE
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State | TX
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Zip | 75833-2497
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Country | US
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Telephone | 903-536-2596
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Fax | 903-536-7609
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | CENTERVILLE
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State | TX
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Zip | 75833-0158
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Country | US
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Telephone | 903-536-2596
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Fax | 903-536-7609
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Authorized Official
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Title or Position | MEDICARE MANAGER
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Name | SHARON ANN RODELL
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Credential | RN
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Telephone | 903-536-2596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 110703
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License Number State | TX
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