Provider Demographics
NPI:1477645679
Name:TROUSDALE FOUNDATION OF DEPORT, INC.
Entity Type:Organization
Organization Name:TROUSDALE FOUNDATION OF DEPORT, INC.
Other - Org Name:DEPORT NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-422-7774
Mailing Address - Street 1:126 US HIGHWAY 271 S
Mailing Address - Street 2:
Mailing Address - City:DEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:75435-2534
Mailing Address - Country:US
Mailing Address - Phone:903-652-4410
Mailing Address - Fax:903-652-2138
Practice Address - Street 1:126 US HIGHWAY 271 S
Practice Address - Street 2:
Practice Address - City:DEPORT
Practice Address - State:TX
Practice Address - Zip Code:75435-2534
Practice Address - Country:US
Practice Address - Phone:903-652-4410
Practice Address - Fax:903-652-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115747314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicare UPIN
67-5843Medicare Oscar/Certification