Provider Demographics
NPI:1558454470
Name:HOUSE CROSS CARE CENTER
Entity Type:Organization
Organization Name:HOUSE CROSS CARE CENTER
Other - Org Name:INDIAN OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCULLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-646-5951
Mailing Address - Street 1:415 INDIAN OAKS
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548
Mailing Address - Country:US
Mailing Address - Phone:254-699-5051
Mailing Address - Fax:254-699-5132
Practice Address - Street 1:415 INDIAN OAKS
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548
Practice Address - Country:US
Practice Address - Phone:254-699-5051
Practice Address - Fax:254-699-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116740314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000232Medicaid
TX162892702Medicaid
TX162892701Medicaid
TX675909Medicare Oscar/Certification
TX000232Medicaid