Provider Demographics
NPI:1487641296
Name:POLK NURSING HOME LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:POLK NURSING HOME LIMITED PARTNERSHIP
Other - Org Name:TIMBERWOOD NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-458-5707
Mailing Address - Street 1:RR 2
Mailing Address - Street 2:HIGHWAY 59 NORTH BYPASS
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9802
Mailing Address - Country:US
Mailing Address - Phone:936-327-4446
Mailing Address - Fax:936-327-8435
Practice Address - Street 1:6633 E HIGHWAY 290
Practice Address - Street 2:SUITE # 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1172
Practice Address - Country:US
Practice Address - Phone:512-458-5707
Practice Address - Fax:512-458-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113278313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH2664OtherBCBS OF TEXAS
TX455745Medicare ID - Type Unspecified