MEDICARE: NACOGDOCHES HEALTH CARE CENTER LTD. CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	108619	TX

General Provider Information

NPI Number	:	1104812411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NACOGDOCHES HEALTH CARE CENTER LTD. CO

Provider Business Mailing Address
First Line	:	2537 GOLDEN BEAR DR
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2377
Country	:	US
Telephone Number	:	214-954-4114
Fax Number	:	214-871-3057

Provider Business Practice Location Address
First Line	:	3305 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2690
Country	:	US
Telephone Number	:	936-564-0256
Fax Number	:	936-564-5298

Authorized Official
Title or Position	:	CHIEF EXECUTIVE
Name	:	MRS. ROBIN UNDERHILL
Credential	:
Telephone Number	:	214-954-4114

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	08/22/2020

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