Provider Demographics
NPI:1518954379
Name:ERATH NURSING HOME LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:ERATH NURSING HOME LIMITED PARTNERSHIP
Other - Org Name:COMMUNITY 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 1:6633 E HIGHWAY 290 STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1157
Mailing Address - Country:US
Mailing Address - Phone:512-458-5707
Mailing Address - Fax:512-458-5751
Practice Address - Street 1:2025 NORTHWEST LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1703
Practice Address - Country:US
Practice Address - Phone:254-968-4649
Practice Address - Fax:254-968-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112718313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455906Medicare ID - Type Unspecified