Provider Demographics
NPI:1609850494
Name:NAVARRO CONVALESCENT, INC.
Entity Type:Organization
Organization Name:NAVARRO CONVALESCENT, INC.
Other - Org Name:HERITAGE OAKS RETIREMENT VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:409-962-0910
Mailing Address - Street 1:3002 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2408
Mailing Address - Country:US
Mailing Address - Phone:903-872-5130
Mailing Address - Fax:
Practice Address - Street 1:3002 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2408
Practice Address - Country:US
Practice Address - Phone:903-872-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111240314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005357Medicaid
TX675581Medicare Oscar/Certification