Organization
FANNIN COUNTY HOSPITAL AUTHORITY
Active
Other names
Heritage Plaza Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
DENVER SHEDDY (BOARD REPRESENTATIVE)
(903) 583-1854
Entity
Organization
Contact information
Practice address
600 W 52ND ST, TEXARKANA, TX 75503-2980
(903) 792-6700
(903) 792-6216
Mailing address
1500 WATERS RIDGE DR, SUITE 200, LEWISVILLE, TX 75057-6011
(972) 899-4401
(972) 899-4460
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
109167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028769
—
TX
01
—
148993201
MEDICAID CO B
TX
Enumeration date
09/07/2005
Last updated
02/08/2022
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