Provider Demographics
NPI:1407889611
Name:HOUSE MEDICAL CONVALESCENT INC
Entity Type:Organization
Organization Name:HOUSE MEDICAL CONVALESCENT INC
Other - Org Name:BELL HAVEN NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SCULLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-646-5951
Mailing Address - Street 1:1002 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-3525
Mailing Address - Country:US
Mailing Address - Phone:254-634-0374
Mailing Address - Fax:254-634-4679
Practice Address - Street 1:1002 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-3525
Practice Address - Country:US
Practice Address - Phone:254-634-0374
Practice Address - Fax:254-634-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117665314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0473640001Medicaid
TX455496Medicare ID - Type Unspecified