Provider Demographics
NPI:1437146925
Name:FAIRVIEW NURSING AND REHABILITATION LP
Entity Type:Organization
Organization Name:FAIRVIEW NURSING AND REHABILITATION LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-387-4388
Mailing Address - Street 1:401 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4137
Mailing Address - Country:US
Mailing Address - Phone:940-387-4388
Mailing Address - Fax:940-380-2410
Practice Address - Street 1:1601 KENNEDY STREET
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2568
Practice Address - Country:US
Practice Address - Phone:903-583-2148
Practice Address - Fax:903-583-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121629314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155171501OtherTMHP (CROSSOVER)
TX001004352Medicaid
TX155171502OtherTMHP (DME CROSSOVER)
TX675419Medicare Oscar/Certification
TX4595510001Medicare NSC