Provider Demographics
NPI:1457384224
Name:TRAVIS HEIGHTS HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TRAVIS HEIGHTS HEALTHCARE, INC.
Other - Org Name:SAINT RICHARDS VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FREDERCICK
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LNFA
Authorized Official - Phone:832-489-9944
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0746
Mailing Address - Country:US
Mailing Address - Phone:940-759-2219
Mailing Address - Fax:940-759-4382
Practice Address - Street 1:15336 US HIGHWAY 82 WEST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252
Practice Address - Country:US
Practice Address - Phone:940-759-2219
Practice Address - Fax:940-759-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122427314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4867Medicaid
TX001014687Medicaid
TX4867Medicaid