Provider Demographics
NPI:1093951428
Name:SULPHUR SPRINGS ELITE HOLDINGS, INC
Entity Type:Organization
Organization Name:SULPHUR SPRINGS ELITE HOLDINGS, INC
Other - Org Name:SUNNY SPRINGS NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UMSHAVENI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-757-5115
Mailing Address - Street 1:PO BOX 185159
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76181-0159
Mailing Address - Country:US
Mailing Address - Phone:972-757-5115
Mailing Address - Fax:817-590-2948
Practice Address - Street 1:1200 JACKSON ST N
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2104
Practice Address - Country:US
Practice Address - Phone:972-757-5115
Practice Address - Fax:817-590-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675664Medicare Oscar/Certification