Provider Demographics
NPI:1760484968
Name:CASCADE NACOGDOCHES HEALTH SERVICES, LTD
Entity Type:Organization
Organization Name:CASCADE NACOGDOCHES HEALTH SERVICES, LTD
Other - Org Name:WILLOWBROOK
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-6633
Mailing Address - Street 1:227 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1238
Mailing Address - Country:US
Mailing Address - Phone:936-564-4596
Mailing Address - Fax:936-564-6824
Practice Address - Street 1:227 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1238
Practice Address - Country:US
Practice Address - Phone:936-564-4596
Practice Address - Fax:936-564-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110594314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455700Medicare Oscar/Certification