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NPI Code Detail

MEDICARE: CORSICANA HEALTH CARE LLC

MEDICARE: CORSICANA HEALTH CARE LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417119116
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORSICANA HEALTH CARE LLC
Provider Business Mailing Address
First Line : 920 RIDGEBROOK RD
Second Line :
City : SPARKS
State : MD
Zip : 21152-9390
Country : US
Telephone Number : 410-773-1000
Fax Number :
Provider Business Practice Location Address
First Line : 3301 W PARK ROW BLVD
Second Line :
City : CORSICANA
State : TX
Zip : 75110-4846
Country : US
Telephone Number : 903-872-2455
Fax Number : 903-874-7286
Authorized Official
Title or Position : PRESIDENT
Name : HERBERT HOUSER
Credential :
Telephone Number : 903-872-2455
Provider Enumeration Date : 06/25/2008
Last Update Date : 09/14/2011

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Directions to “CORSICANA HEALTH CARE LLC ” Practice Location

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