Provider Demographics
NPI:1003898263
Name:HERITAGE HOUSE NURSING AND REHABILITATION LP
Entity Type:Organization
Organization Name:HERITAGE HOUSE NURSING AND REHABILITATION LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-387-4388
Mailing Address - Street 1:401 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4137
Mailing Address - Country:US
Mailing Address - Phone:940-387-4388
Mailing Address - Fax:940-380-2410
Practice Address - Street 1:407 N. COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:TX
Practice Address - Zip Code:76570-0656
Practice Address - Country:US
Practice Address - Phone:254-583-7904
Practice Address - Fax:254-583-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115577314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004237Medicaid
TX1553324201OtherTMHP DME CROSS OVER
TX155392701OtherTMHP CROSS OVER
TX155392701OtherTMHP CROSS OVER
TX1553324201OtherTMHP DME CROSS OVER