Provider Demographics
NPI:1346237179
Name:HOLIDAY LODGE HEALTHCARE CENTER
Entity Type:Organization
Organization Name:HOLIDAY LODGE HEALTHCARE CENTER
Other - Org Name:SENIOR LIVING PROPERTIES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOVNNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROYSDON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:325-576-3643
Mailing Address - Street 1:425 SW AVENUE F
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:TX
Mailing Address - Zip Code:79520-4615
Mailing Address - Country:US
Mailing Address - Phone:325-576-3643
Mailing Address - Fax:325-576-3913
Practice Address - Street 1:558 COUNTY ROAD 423
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-9030
Practice Address - Country:US
Practice Address - Phone:940-864-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675411314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility