Provider Demographics
NPI:1447596374
Name:THROCKMORTON HEALTHCARE INC
Entity Type:Organization
Organization Name:THROCKMORTON HEALTHCARE INC
Other - Org Name:THROCKMORTON NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:UMSHAVENI
Authorized Official - Middle Name:PAM
Authorized Official - Last Name:GOVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-9927
Mailing Address - Street 1:8204 ELMBROOK DRIVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-7216
Mailing Address - Country:US
Mailing Address - Phone:469-893-9927
Mailing Address - Fax:469-218-0345
Practice Address - Street 1:1000 N MINTER AVE
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-4900
Practice Address - Country:US
Practice Address - Phone:940-849-2861
Practice Address - Fax:940-849-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004246314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675094Medicare Oscar/Certification