Provider Demographics
NPI:1508853334
Name:CANTONHEALTHCARE CENTER
Entity Type:Organization
Organization Name:CANTONHEALTHCARE CENTER
Other - Org Name:SENIOR LIVING PROPERTIES
Other - Org Type:Other Name
Authorized Official - Title/Position:MDS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-567-4135
Mailing Address - Street 1:1661 S BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2619
Mailing Address - Country:US
Mailing Address - Phone:903-567-4135
Mailing Address - Fax:903-567-1077
Practice Address - Street 1:1661 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2619
Practice Address - Country:US
Practice Address - Phone:903-567-4135
Practice Address - Fax:903-567-1077
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
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00483606Medicaid
TX455987Medicare ID - Type Unspecified