Provider Demographics
NPI:1659357416
Name:COVENANT CARE CENTERS, LLC DBA ARCHER CITY NURSING CENTER
Entity Type:Organization
Organization Name:COVENANT CARE CENTERS, LLC DBA ARCHER CITY NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MUOI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:940-574-4551
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:ARCHER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76351-0786
Mailing Address - Country:US
Mailing Address - Phone:940-574-4551
Mailing Address - Fax:940-574-2366
Practice Address - Street 1:201 E CHESTNUT
Practice Address - Street 2:
Practice Address - City:ARCHER CITY
Practice Address - State:TX
Practice Address - Zip Code:76351
Practice Address - Country:US
Practice Address - Phone:940-574-4551
Practice Address - Fax:940-574-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171259313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675610Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER