Provider Demographics
NPI:1205823432
Name:TERRY HAVEN NURSING AND REHABILITATION LP
Entity Type:Organization
Organization Name:TERRY HAVEN 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 1:424 US 67 WEST
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-0519
Practice Address - Country:US
Practice Address - Phone:903-537-4332
Practice Address - Fax:903-537-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110278314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0945248-03OtherTMHP (CROSS-OVER)
TX001004516Medicaid
TX1564700-01OtherTMHP (DME CROSS-OVER)
TX0945248-03OtherTMHP (CROSS-OVER)
TX675861Medicare Oscar/Certification