Provider Demographics
NPI:1780637512
Name:CITY OF ENNIS
Entity Type:Organization
Organization Name:CITY OF ENNIS
Other - Org Name:LINDALE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-875-1234
Mailing Address - Street 1:215 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-3215
Mailing Address - Country:US
Mailing Address - Phone:903-882-7561
Mailing Address - Fax:903-882-9797
Practice Address - Street 1:215 MARGARET ST.
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771
Practice Address - Country:US
Practice Address - Phone:903-882-7561
Practice Address - Fax:903-882-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2021-03-25
Deactivation Date:2006-05-25
Deactivation Code:
Reactivation Date:2006-11-15
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004319OtherFACILITY ID NO.
TX004319OtherFACILITY ID NO.
TX455972Medicare ID - Type Unspecified