Provider Demographics
NPI:1083679666
Name:GOLDTHWAITE SENIOR HEALTH CENTER, INC
Entity Type:Organization
Organization Name:GOLDTHWAITE SENIOR HEALTH CENTER, INC
Other - Org Name:GOLDTHWAITE SENIOR HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-256-3787
Mailing Address - Street 1:1515 HERITAGE DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3256
Mailing Address - Country:US
Mailing Address - Phone:214-256-3787
Mailing Address - Fax:214-256-3789
Practice Address - Street 1:1207 S REYNOLDS
Practice Address - Street 2:POB 607
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844
Practice Address - Country:US
Practice Address - Phone:325-648-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4411314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676086Medicare ID - Type Unspecified