Provider Demographics
NPI:1427046127
Name:OVERTON HEALTHCARE CENTER
Entity Type:Organization
Organization Name:OVERTON HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADON/MEDICARE CASE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-834-6616
Mailing Address - Street 1:1110 STATE HIGHWAY 135 S
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:TX
Mailing Address - Zip Code:75684-1924
Mailing Address - Country:US
Mailing Address - Phone:903-934-6616
Mailing Address - Fax:903-834-6400
Practice Address - Street 1:1110 STATE HIGHWAY 135 S
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:TX
Practice Address - Zip Code:75684-1924
Practice Address - Country:US
Practice Address - Phone:903-934-6616
Practice Address - Fax:903-834-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110665314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility