Provider Demographics
NPI:1356328215
Name:HEARTWAY III CORPORATION
Entity type:Organization
Organization Name:HEARTWAY III CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:OBERGFELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-777-0282
Mailing Address - Street 1:700 N HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956-1518
Mailing Address - Country:US
Mailing Address - Phone:409-423-6111
Mailing Address - Fax:409-423-5807
Practice Address - Street 1:700 N HERNDON AVE
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956-1518
Practice Address - Country:US
Practice Address - Phone:409-423-6111
Practice Address - Fax:409-423-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112142314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-5220Medicare Oscar/Certification