Basic Information
| Provider Information | |||||||||
| NPI: | 1124697933 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STRATFORD HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CARADAY OF MINEOLA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 716 MIMOSA DR | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757732612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126418805 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 716 MIMOSA DR | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757732612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035695366 | ||||||||
| FaxNumber: | 9035699050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2021 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHUMLEY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8063965568 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.