Provider Demographics
NPI:1013981794
Name:NEW GRAHAM OAKS CARE CENTER INC.
Entity Type:Organization
Organization Name:NEW GRAHAM OAKS CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WILLMETH
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:940-549-8787
Mailing Address - Street 1:1325 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3603
Mailing Address - Country:US
Mailing Address - Phone:940-549-8787
Mailing Address - Fax:994-054-9557
Practice Address - Street 1:1325 1ST ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3603
Practice Address - Country:US
Practice Address - Phone:940-549-8787
Practice Address - Fax:994-054-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114203314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5241OtherVENDER NUMBER
TX5241OtherVENDER NUMBER