Provider Demographics
NPI:1619955416
Name:HEARTWAY III CORPORATION
Entity Type:Organization
Organization Name:HEARTWAY III CORPORATION
Other - Org Name:AVALON PLACE-TRINITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:OBERGFELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-777-0282
Mailing Address - Street 1:808 S ROBB ST
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-7602
Mailing Address - Country:US
Mailing Address - Phone:936-594-7521
Mailing Address - Fax:936-594-3430
Practice Address - Street 1:808 S ROBB ST
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-7602
Practice Address - Country:US
Practice Address - Phone:936-594-7521
Practice Address - Fax:936-594-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101709314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-5900Medicare Oscar/Certification