MEDICARE: CASCADE NACOGDOCHES HEALTH SERVICES, LTD

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	110594	TX

General Provider Information

NPI Number	:	1760484968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE NACOGDOCHES HEALTH SERVICES, LTD

Provider Business Mailing Address
First Line	:	227 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1238
Country	:	US
Telephone Number	:	936-564-4596
Fax Number	:	936-564-6824

Provider Business Practice Location Address
First Line	:	227 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1238
Country	:	US
Telephone Number	:	936-564-4596
Fax Number	:	936-564-6824

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	MR. RONALD M. HANEY
Credential	:
Telephone Number	:	936-634-6633

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/26/2008

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