Provider Demographics
NPI:1104947811
Name:TOWN HALL ESTATES-KEENE INC
Entity type:Organization
Organization Name:TOWN HALL ESTATES-KEENE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:FAUTHEREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-645-8888
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-0588
Mailing Address - Country:US
Mailing Address - Phone:817-645-8888
Mailing Address - Fax:817-645-4984
Practice Address - Street 1:207 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2426
Practice Address - Country:US
Practice Address - Phone:817-645-8888
Practice Address - Fax:817-645-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116903313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000440202Medicaid
TX000440202Medicaid