Southhaven Enterprises, LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

4917 Issued in TX

Legal business name

SOUTHHAVEN ENTERPRISES, LLC

Practice address

5300 Houston School Rd
Dallas, TX 75241-1219

Phone

(214) 372-1496

Fax

(214) 374-7333

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Dee Bates

Title

Owner

Phone

(940) 864-3619

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southaven Nursing Center Doing business as

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1235237462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 HOUSTON SCHOOL RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752411219",
            "telephone_number": "214-372-1496",
            "fax_number": "214-374-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 HOUSTON SCHOOL RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752411219",
            "telephone_number": "214-372-1496",
            "fax_number": "214-374-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHHAVEN ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "DEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "940-864-3619",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "4917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001012292",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southaven Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nursing Facility/Intermediate Care Facility in Dallas, TX
• Providers in Dallas, TX by specialty
• Nursing Facility/Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.