Provider Demographics
NPI:1609931823
Name:DANFORTH GARDENS NURSING & REHABILITATION, L.P.
Entity Type:Organization
Organization Name:DANFORTH GARDENS NURSING & REHABILITATION, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOFTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-479-0844
Mailing Address - Street 1:519 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-6316
Mailing Address - Country:US
Mailing Address - Phone:409-949-9499
Mailing Address - Fax:409-949-9994
Practice Address - Street 1:519 9TH AVE N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6316
Practice Address - Country:US
Practice Address - Phone:409-949-9499
Practice Address - Fax:409-949-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114224314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5368Medicaid
TX5368Medicaid