Provider Demographics
NPI:1376837138
Name:SOUTHWEST LTC KELLER, LLC
Entity Type:Organization
Organization Name:SOUTHWEST LTC KELLER, LLC
Other - Org Name:HERITAGE HOUSE OF KELLER HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-916-6100
Mailing Address - Street 1:1150 WHITLEY RD
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3038
Mailing Address - Country:US
Mailing Address - Phone:817-431-2518
Mailing Address - Fax:469-916-6105
Practice Address - Street 1:1150 WHITLEY RD
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3038
Practice Address - Country:US
Practice Address - Phone:817-431-2518
Practice Address - Fax:469-916-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility