Provider Demographics
NPI:1932106051
Name:IHS ACQUISITION NO 132 INC
Entity Type:Organization
Organization Name:IHS ACQUISITION NO 132 INC
Other - Org Name:HERITAGE GARDENS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-539-2354
Mailing Address - Street 1:2135 DENTON DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3103
Mailing Address - Country:US
Mailing Address - Phone:972-242-0667
Mailing Address - Fax:972-242-8641
Practice Address - Street 1:2135 DENTON DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3103
Practice Address - Country:US
Practice Address - Phone:972-242-0667
Practice Address - Fax:972-242-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112805314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675111Medicare ID - Type Unspecified