Provider Demographics
NPI:1497702211
Name:FAIRVIEW HEALTHCARE RESIDENCE LTD.
Entity Type:Organization
Organization Name:FAIRVIEW HEALTHCARE RESIDENCE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, COO FHCR INC. GEN. PTR.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MARWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-753-7367
Mailing Address - Street 1:2524 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7418
Mailing Address - Country:US
Mailing Address - Phone:254-753-7367
Mailing Address - Fax:254-753-5776
Practice Address - Street 1:601 E REUNION ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1634
Practice Address - Country:US
Practice Address - Phone:903-389-4121
Practice Address - Fax:903-389-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113530314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675311Medicare ID - Type Unspecified