Provider Demographics
NPI:1821084138
Name:LIVINGSTON HEALTH CARE CENTER LTD. CO.
Entity Type:Organization
Organization Name:LIVINGSTON HEALTH CARE CENTER LTD. CO.
Other - Org Name:THE BRADFORD AT BROOKSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-954-4114
Mailing Address - Street 1:2537 GOLDEN BEAR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2377
Mailing Address - Country:US
Mailing Address - Phone:214-954-4114
Mailing Address - Fax:214-871-3057
Practice Address - Street 1:301 WEST PARK DRIVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8151
Practice Address - Country:US
Practice Address - Phone:936-327-4341
Practice Address - Fax:936-327-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114558314000000X
TX332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022634201Medicaid
TX155314101Medicaid
TXHH068SOtherBLUE CROSS
TX000465804Medicaid
TX675539Medicare Oscar/Certification
1306500001Medicare NSC