Gardendale HH Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GARDENDALE HH OPCO LLC

Practice address

1521 E Rusk St
Jacksonville, TX 75766-5505

Phone

(903) 586-3626

Fax

(903) 586-2766

NPI assigned

May 15, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Little

Title

Manager

Phone

(888) 396-3462

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gardendale Healthcare Residence Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566345600000",
    "number": "1093371064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757665505",
            "telephone_number": "888-396-3462",
            "fax_number": "214-396-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 E RUSK ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757665505",
            "telephone_number": "903-586-3626",
            "fax_number": "903-586-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDENDALE HH OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-08-21",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "888-396-3462"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY LICENSE",
            "identifier": "004986",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlittle@serenityhcm.com",
            "affiliation": "N",
            "endpointDescription": "work email address",
            "address_1": "1521 E Rusk St",
            "city": "Jacksonville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757665505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Gardendale Healthcare Residence",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gardendale Healthcare Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Lee Faulkner, LPC
• Lynsie Ann Fisher, LPC
• Thomas Fitzpatrick, M.D.
• Larry Lofton Folden, D.D.S.
• Ryan Dean Ford, M.D.
• Gardendale Rehabilitation & Nursing Center, L.P.
• Gardendale SNF LLC
• Gateway Community Partners Inc.
• Paul Steven Glass, D.D.S.
• Leslie Z Glover, LPC

• Skilled Nursing Facility in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.