Provider Demographics
NPI:1437124716
Name:MODERN HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:MODERN HEALTH SYSTEMS, INC.
Other - Org Name:HIGHLAND PARK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-379-6255
Mailing Address - Street 1:2007 SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6889
Mailing Address - Country:US
Mailing Address - Phone:817-379-6255
Mailing Address - Fax:
Practice Address - Street 1:2714 MORRISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-7614
Practice Address - Country:US
Practice Address - Phone:713-862-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4062314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-5493Medicare ID - Type UnspecifiedMEDICARE PROVIDER #