Basic Information
| Provider Information | |||||||||
| NPI: | 1033594478 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GIBSON CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795022029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893551 | ||||||||
| FaxNumber: | 9409893395 | ||||||||
| Practice Location | |||||||||
| Address1: | 931 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893526 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | STEMMERDING | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9409893526 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STONEWALL MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.