Provider Demographics
NPI:1881680106
Name:GAINESVILLE HEALTH CARE CENTER LTD. CO
Entity Type:Organization
Organization Name:GAINESVILLE HEALTH CARE CENTER LTD. CO
Other - Org Name:RENAISSANCE CARE CENTER
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:CARROLLTON
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 1:1400 BLACK HILL DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4625
Practice Address - Country:US
Practice Address - Phone:940-665-5221
Practice Address - Fax:940-665-0306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANTEX HEALTH CARE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110722314000000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
675441Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
5439350001Medicare NSC