Provider Demographics
NPI:1689836645
Name:HERITAGE PARK OF KATY LLC
Entity Type:Organization
Organization Name:HERITAGE PARK OF KATY LLC
Other - Org Name:HERITAGE PARK OF KATY NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-826-3382
Mailing Address - Street 1:6001 GEORGE BUSH DRIVE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1991
Mailing Address - Country:US
Mailing Address - Phone:281-395-1124
Mailing Address - Fax:281-395-1111
Practice Address - Street 1:6001 GEORGE BUSH DRIVE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1991
Practice Address - Country:US
Practice Address - Phone:281-395-1124
Practice Address - Fax:281-395-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001016156313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016156Medicaid