Provider Demographics
NPI:1245664994
Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-937-6371
Mailing Address - Street 1:1316 S FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-6306
Mailing Address - Country:US
Mailing Address - Phone:940-567-6633
Mailing Address - Fax:940-567-3975
Practice Address - Street 1:1316 S FLORIDA ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-6306
Practice Address - Country:US
Practice Address - Phone:940-567-6633
Practice Address - Fax:940-567-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005044Medicaid