Town Hall Estates-Keene Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

116903 Issued in TX

Legal business name

TOWN HALL ESTATES-KEENE INC

Practice address

207 S Old Betsy Rd
Keene, TX 76059-2426

Phone

(817) 645-8888

Fax

(817) 645-4984

NPI assigned

Apr 2, 2007

Last updated

Apr 6, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William Jason Fautheree

Title

Administrator

Phone

(817) 645-8888

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104947811. Details of each certification follow.

• CCN 676047 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 676047

Legal name

TOWN HALL ESTATES-KEENE INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 31, 2005

Last certification

Jun 6, 2024

Beds

126

Ownership / control type

Nonprofit Corporation

Multi-facility organization

American Religious Town Hall

Organization structure

CorporationNon-profit

Incorporated

Mar 14, 1988 in TX

Enrollment address

207 S Old Betsy Rd
Keene, TX 76059-2426

Nursing home name

TOWN HALL ESTATES KEENE INC

Listed as

Town Hall Estates Keene IncCCN 676047 · All quality measures

Overall star rating

3 of 5

Health inspections

4 of 5

Staffing

1 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Mar 31, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

126100.3 residents per day on average

Penalties (3 years)

2Fines totaling $16,209

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Town Hall Estates Keene2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Town Hall Estates Keene, Inc

  • Long Term Care Hospital
  • Keene, TX
  • NPI 1184098964
  NPD tax ID

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Bamidele Daramola, MD

  • Internal Medicine Physician
  • Cleburne, TX
  • NPI 1013995810
  NPD (past)
• Syed M Jamal, MD

  • Internal Medicine Physician
  • Jacksboro, TX
  • NPI 1437157419
  NPD (past)
• McDavid M Mahaffey, MD

  • Family Medicine Physician
  • Cleburne, TX
  • NPI 1124163811
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• John Bamidele Daramola, MD

  • Internal Medicine Physician
  • Cleburne, TX
  • NPI 1013995810

  Nursing home

  Care Compare affiliation
• McDavid M Mahaffey, MD

  • Family Medicine Physician
  • Cleburne, TX
  • NPI 1124163811

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428278400000",
    "number": "1104947811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 588",
            "city": "KEENE",
            "state": "TX",
            "postal_code": "760590588",
            "telephone_number": "817-645-8888",
            "fax_number": "817-645-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 S OLD BETSY RD",
            "city": "KEENE",
            "state": "TX",
            "postal_code": "760592426",
            "telephone_number": "817-645-8888",
            "fax_number": "817-645-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN HALL ESTATES-KEENE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2015-04-06",
        "status": "A",
        "authorized_official_last_name": "FAUTHEREE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-645-8888",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "116903",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "116903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000440202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Sorensen, FNP
• Janeen Stumph, COTA
• Rashmi Thapa, DDS
• Amy Tharp, M.S., CCC-SLP
• Town Hall Estates Keene, Inc
• Farren Watson
• Heather Weaver, LMT
• Wellspring Psychological Associates

• Skilled Nursing Facility in Keene, TX
• Providers in Keene, 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 Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.