Basic Information
| Provider Information | |||||||||
| NPI: | 1437113701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WINDSOR NURSING CENTER PARTNERS OF HALLETTSVILLE, LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STEVENS NURSING AND REHABILITATION CENTER OF HALLETTSVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 KAHN ST | ||||||||
| Address2: | |||||||||
| City: | HALLETTSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779642177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617983606 | ||||||||
| FaxNumber: | 3617989950 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 KAHN ST | ||||||||
| Address2: | |||||||||
| City: | HALLETTSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779642177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617983606 | ||||||||
| FaxNumber: | 3617989950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LACERDA | ||||||||
| AuthorizedOfficialFirstName: | HEBER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3615760694 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 112793 | TX | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 332B00000X | 5604000001 | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | 314000000X | 675226 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 470103 | 05 | TX | MEDICAID |