Basic Information
Provider Information
NPI: 1124662432
EntityType: 2
ReplacementNPI:  
OrganizationName: NORTH RUNNELS COUNTY HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WINTERS HEALTHCARE AND REHABILITATION CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 506 VAN NESS ST
Address2:  
City: WINTERS
State: TX
PostalCode: 795674724
CountryCode: US
TelephoneNumber: 3257544566
FaxNumber:  
Practice Location
Address1: 506 VAN NESS ST
Address2:  
City: WINTERS
State: TX
PostalCode: 795674724
CountryCode: US
TelephoneNumber: 3257544566
FaxNumber: 3257544634
Other Information
ProviderEnumerationDate: 10/30/2019
LastUpdateDate: 07/06/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: TUCKER
AuthorizedOfficialFirstName: SIDNEY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 3257541500
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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