Provider Demographics
NPI:1598708497
Name:HEARTHSTONE HEALTH CENTER
Entity Type:Organization
Organization Name:HEARTHSTONE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-703-2193
Mailing Address - Street 1:401 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4067
Mailing Address - Country:US
Mailing Address - Phone:512-388-7494
Mailing Address - Fax:512-388-2166
Practice Address - Street 1:401 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4067
Practice Address - Country:US
Practice Address - Phone:512-388-7494
Practice Address - Fax:512-388-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005264314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455771Medicare ID - Type UnspecifiedMEDICARE PROVIDER #