MSHC the Waterton at Cowhorn Creek, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

115905 Issued in TX

Legal business name

MSHC THE WATERTON AT COWHORN CREEK, LLC

Practice address

5524 Cowhorn Creek Rd
Texarkana, TX 75503-9101

Phone

(903) 228-1188

Fax

(903) 838-1229

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

Carla Power

Title

Cfo

Phone

(903) 534-8667

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1255497137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 RICKETY LN",
            "address_2": "STE 208",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031703",
            "telephone_number": "903-534-8667",
            "fax_number": "903-509-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039101",
            "telephone_number": "903-228-1188",
            "fax_number": "903-838-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSHC THE WATERTON AT COWHORN CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "POWER",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "903-534-8667"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "115905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001013766",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Texarkana, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.