Provider Demographics
NPI:1295722015
Name:CENTERVILLE HEALTHCARE CENTER
Entity type:Organization
Organization Name:CENTERVILLE HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RODELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-536-2596
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75833-0158
Mailing Address - Country:US
Mailing Address - Phone:903-536-2596
Mailing Address - Fax:903-536-7609
Practice Address - Street 1:103 TEAKWOOD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TX
Practice Address - Zip Code:75833-2497
Practice Address - Country:US
Practice Address - Phone:903-536-2596
Practice Address - Fax:903-536-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110703314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility